Provider Demographics
NPI:1447714597
Name:IYER, VINATA MAHADEVAN
Entity type:Individual
Prefix:MRS
First Name:VINATA
Middle Name:MAHADEVAN
Last Name:IYER
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 1:5345 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2427
Mailing Address - Country:US
Mailing Address - Phone:862-221-5817
Mailing Address - Fax:
Practice Address - Street 1:215 E BIG BEAVER RD STE 100
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1216
Practice Address - Country:US
Practice Address - Phone:313-451-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223979101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor