Healthcare Provider Details

I. General information

NPI: 1235645847
Provider Name (Legal Business Name): ENCOMPASS THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 KATALIN CT
BAY CITY MI
48706-2160
US

IV. Provider business mailing address

3710 KATALIN CT
BAY CITY MI
48706-2160
US

V. Phone/Fax

Practice location:
  • Phone: 989-324-8924
  • Fax:
Mailing address:
  • Phone: 989-324-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-17456
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ASHLEY NICOLE BLAKE
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: M.S., BCBA
Phone: 989-324-8924