Provider Demographics
NPI:1639859341
Name:CHAMBERLAIN-SCOTT, STIHLYN
Entity Type:Individual
Prefix:
First Name:STIHLYN
Middle Name:
Last Name:CHAMBERLAIN-SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STIHLYN
Other - Middle Name:
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1411 OAK VALLEY DR APT 103
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-8934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31478 INDUSTRIAL RD STE 300
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1840
Practice Address - Country:US
Practice Address - Phone:734-245-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351004693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical