Healthcare Provider Details

I. General information

NPI: 1609693878
Provider Name (Legal Business Name): MICHIGAN THERAPY TODAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 W LAKE LANSING RD STE 200
EAST LANSING MI
48823-8452
US

IV. Provider business mailing address

780 W LAKE LANSING RD STE 200
EAST LANSING MI
48823-8452
US

V. Phone/Fax

Practice location:
  • Phone: 517-420-6976
  • Fax:
Mailing address:
  • Phone: 517-420-6976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLA P CANTU
Title or Position: BUSINESS MANAGER
Credential:
Phone: 517-420-6976