Provider Demographics
NPI:1356048466
Name:SUBRAMANIAM, MAVATH SAILAJA (LMFT)
Entity type:Individual
Prefix:DR
First Name:MAVATH SAILAJA
Middle Name:
Last Name:SUBRAMANIAM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:DR
Other - First Name:SAILA
Other - Middle Name:
Other - Last Name:SUBRAMANIAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1669 WOLF CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-7712
Mailing Address - Country:US
Mailing Address - Phone:517-927-6609
Mailing Address - Fax:
Practice Address - Street 1:91 JALAN LIMAU PURUT
Practice Address - Street 2:
Practice Address - City:KUALA LUMPUR
Practice Address - State:FEDERAL TERRITORY
Practice Address - Zip Code:59000
Practice Address - Country:MY
Practice Address - Phone:012-936-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006863106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist