Provider Demographics
NPI:1851578983
Name:YOON, JINA (PHD)
Entity Type:Individual
Prefix:
First Name:JINA
Middle Name:
Last Name:YOON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 ANDREA LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2121
Mailing Address - Country:US
Mailing Address - Phone:248-661-7501
Mailing Address - Fax:
Practice Address - Street 1:74 W LONG LAKE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2769
Practice Address - Country:US
Practice Address - Phone:248-642-6066
Practice Address - Fax:248-642-5739
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011884103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral