Provider Demographics
NPI:1720575889
Name:ARCHAMBAULT, JEFF JOSEPH (MA LLP)
Entity Type:Individual
Prefix:MR
First Name:JEFF
Middle Name:JOSEPH
Last Name:ARCHAMBAULT
Suffix:
Gender:M
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 JANLAIN CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2804
Mailing Address - Country:US
Mailing Address - Phone:248-672-0143
Mailing Address - Fax:
Practice Address - Street 1:29895 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5867
Practice Address - Country:US
Practice Address - Phone:248-672-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008628103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist