Provider Demographics
NPI:1811452659
Name:PRITCHETT, EMILY RUTH (MA TLLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RUTH
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:MA TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 CARDWELL ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2548
Mailing Address - Country:US
Mailing Address - Phone:734-536-6833
Mailing Address - Fax:
Practice Address - Street 1:28303 JOY RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-5524
Practice Address - Country:US
Practice Address - Phone:734-513-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017601103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical