Provider Demographics
NPI:1972624716
Name:MANSOUR, DENISE F (PSYD, LLP, CTS)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:F
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:PSYD, LLP, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0358
Mailing Address - Country:US
Mailing Address - Phone:248-202-4192
Mailing Address - Fax:
Practice Address - Street 1:28175 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2903
Practice Address - Country:US
Practice Address - Phone:734-265-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013014103TC0700X
MI6361003557103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid