Healthcare Provider Details

I. General information

NPI: 1558141523
Provider Name (Legal Business Name): JOHNATHAN PLATT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S ASHLEY ST STE C
ANN ARBOR MI
48104-1369
US

IV. Provider business mailing address

225 S ASHLEY ST STE 201
ANN ARBOR MI
48104-1369
US

V. Phone/Fax

Practice location:
  • Phone: 313-818-1814
  • Fax:
Mailing address:
  • Phone: 313-444-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401226355
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: