Healthcare Provider Details

I. General information

NPI: 1255268744
Provider Name (Legal Business Name): TINY TRAILS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 STANLEY AVE
ALLEN PARK MI
48101-3527
US

IV. Provider business mailing address

4031 STANLEY AVE
ALLEN PARK MI
48101-3527
US

V. Phone/Fax

Practice location:
  • Phone: 734-883-0358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIAM SALEH
Title or Position: BCBA
Credential:
Phone: 734-883-0358