Provider Demographics
NPI:1629591185
Name:SIMPLY BECOME, PLLC
Entity Type:Organization
Organization Name:SIMPLY BECOME, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MARYSE
Authorized Official - Last Name:SHAPERO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:248-246-6767
Mailing Address - Street 1:32841 MIDDLEBELT RD STE 405
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1771
Mailing Address - Country:US
Mailing Address - Phone:248-246-6767
Mailing Address - Fax:248-246-2247
Practice Address - Street 1:32841 MIDDLEBELT RD STE 405
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1771
Practice Address - Country:US
Practice Address - Phone:248-246-6767
Practice Address - Fax:248-246-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015580261QM0801X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)