Provider Demographics
NPI:1447028725
Name:BARAJAS ROJAS, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:BARAJAS ROJAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 E BROOMFIELD ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4493
Mailing Address - Country:US
Mailing Address - Phone:323-671-9773
Mailing Address - Fax:
Practice Address - Street 1:1040 E BROOMFIELD ST APT 2F
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4493
Practice Address - Country:US
Practice Address - Phone:323-671-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352000888103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical