Healthcare Provider Details

I. General information

NPI: 1639691116
Provider Name (Legal Business Name): ALLIANCE THERAPY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 CRYSTAL SPRING AVE
ADRIAN MI
49221-3207
US

IV. Provider business mailing address

366 CRYSTAL SPRING AVE
ADRIAN MI
49221-3207
US

V. Phone/Fax

Practice location:
  • Phone: 517-662-5084
  • Fax:
Mailing address:
  • Phone: 517-662-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011293
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301013012
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE MAY YOUNGLOVE
Title or Position: OWNER
Credential: MA, LLP
Phone: 517-662-5084