MEDICARE: BOUND TOGETHER COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM0850X	Adult Mental Health Clinic/Center
4	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700492154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUND TOGETHER COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 10
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-0010
Country	:	US
Telephone Number	:	517-676-9788
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 FRANKLIN PARK DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2477
Country	:	US
Telephone Number	:	313-626-0160
Fax Number	:	586-261-5458

Authorized Official
Title or Position	:	OWNER/FOUNDER
Name	:	MS. STEFANI ELIZABETH GOERLICH
Credential	:	LMSW
Telephone Number	:	313-626-0160

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	11/12/2020

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Directions to “BOUND TOGETHER COUNSELING, PLLC ” Practice Location

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