Healthcare Provider Details

I. General information

NPI: 1588841787
Provider Name (Legal Business Name): PLACE COUNSELING LLC DBA TREESIDE PSYCHOLOGICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 05/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N LAPEER STREET
LAKE ORION MI
48362-3159
US

IV. Provider business mailing address

45 N LAPEER STREET
LAKE ORION MI
48362-3159
US

V. Phone/Fax

Practice location:
  • Phone: 248-693-9614
  • Fax: 248-693-9615
Mailing address:
  • Phone: 248-693-9614
  • Fax: 248-693-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER R PLACE
Title or Position: CO-OWNER
Credential: MA, LPC
Phone: 248-693-9614