Healthcare Provider Details

I. General information

NPI: 1295129799
Provider Name (Legal Business Name): THERASUPPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 01/02/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 CONCOURSE DR. SUITE 250
ANN ARBOR MI
48108-8672
US

IV. Provider business mailing address

4343 CONCOURSE DR. SUITE 250
ANN ARBOR MI
48108-8672
US

V. Phone/Fax

Practice location:
  • Phone: 734-677-0200
  • Fax: 734-677-3310
Mailing address:
  • Phone: 734-677-0200
  • Fax: 734-677-3310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301001432
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5201007359
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101001686
License Number StateMI

VIII. Authorized Official

Name: MS. CHRISTY L DELPH
Title or Position: OFFICE MANAGER
Credential:
Phone: 734-677-0200