Healthcare Provider Details

I. General information

NPI: 1124688353
Provider Name (Legal Business Name): THE GENTLE CARESS L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32729 GRAND RIVER AVE STE B
FARMINGTON MI
48336-3113
US

IV. Provider business mailing address

32729 GRAND RIVER AVE STE B
FARMINGTON MI
48336-3113
US

V. Phone/Fax

Practice location:
  • Phone: 248-266-4331
  • Fax: 248-301-0930
Mailing address:
  • Phone: 248-266-4331
  • Fax: 248-301-0930

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYSHARD PARKER
Title or Position: OWNER
Credential:
Phone: 248-266-4331