Healthcare Provider Details

I. General information

NPI: 1063278265
Provider Name (Legal Business Name): SERAPHINE THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 HAYNES ST STE 245
BIRMINGHAM MI
48009-6702
US

IV. Provider business mailing address

2581 BLOOMFIELD XING
BLOOMFIELD HILLS MI
48304-1707
US

V. Phone/Fax

Practice location:
  • Phone: 248-238-8202
  • Fax:
Mailing address:
  • Phone: 269-615-6804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SARYN CELESTE ULRICH
Title or Position: THERAPIST/OWNER
Credential: LMSW, LCSW
Phone: 269-615-6804