Healthcare Provider Details

I. General information

NPI: 1598526659
Provider Name (Legal Business Name): EMBOLDENED PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33966 W 8 MILE RD STE 101
FARMINGTON HILLS MI
48335-5273
US

IV. Provider business mailing address

PO BOX 40706
REDFORD MI
48240-0706
US

V. Phone/Fax

Practice location:
  • Phone: 248-788-6408
  • Fax:
Mailing address:
  • Phone: 810-210-8462
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARMEN COCHRAN
Title or Position: OWNER, CEO
Credential:
Phone: 810-210-8462