Healthcare Provider Details

I. General information

NPI: 1629758081
Provider Name (Legal Business Name): RESILIENCE MENTAL HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 E GRAND BLVD STE 600
DETROIT MI
48202-3120
US

IV. Provider business mailing address

1075 COUNTRY COACH DR
HENDERSON NV
89002-8941
US

V. Phone/Fax

Practice location:
  • Phone: 231-239-6101
  • Fax: 231-251-8267
Mailing address:
  • Phone: 231-239-6101
  • Fax: 231-251-8267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DEVAN STEVENS
Title or Position: CEO
Credential:
Phone: 702-578-6271