Provider Demographics
NPI:1710970116
Name:BALAJI, JAYSHRI (MA,)
Entity Type:Individual
Prefix:
First Name:JAYSHRI
Middle Name:
Last Name:BALAJI
Suffix:
Gender:F
Credentials:MA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40977 SCARBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-5701
Mailing Address - Country:US
Mailing Address - Phone:248-231-9975
Mailing Address - Fax:
Practice Address - Street 1:43000 W 9 MILE RD STE 109
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4180
Practice Address - Country:US
Practice Address - Phone:248-660-9164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009306101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0733595107OtherLIABILITY INSURANCE