Healthcare Provider Details

I. General information

NPI: 1982246286
Provider Name (Legal Business Name): SOUL GROWTH PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 SLEETH RD
COMMERCE TWP MI
48382-1670
US

IV. Provider business mailing address

3760 SLEETH RD
COMMERCE TWP MI
48382-1670
US

V. Phone/Fax

Practice location:
  • Phone: 248-840-5933
  • Fax:
Mailing address:
  • Phone: 248-840-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH J TUPLING
Title or Position: PRESIDENT
Credential: MS, LLP
Phone: 248-840-5933