Provider Demographics
NPI:1760805766
Name:TEMPLE, AJA C (PHD)
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:C
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AJA
Other - Middle Name:C
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30665 NORTHWESTERN HWY STE 255
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-871-7457
Practice Address - Fax:248-254-3333
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015829103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist