Healthcare Provider Details

I. General information

NPI: 1093562795
Provider Name (Legal Business Name): BEUPLIFTED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15001 KERCHEVAL AVE PMB 527
GROSSE POINTE PARK MI
48230-1361
US

IV. Provider business mailing address

15001 KERCHEVAL AVE PMB 527
GROSSE POINTE PARK MI
48230-1361
US

V. Phone/Fax

Practice location:
  • Phone: 313-263-7245
  • Fax:
Mailing address:
  • Phone: 313-263-7245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHELLIE CROOK
Title or Position: OWNER
Credential: LLMFT
Phone: 313-263-7245