Healthcare Provider Details

I. General information

NPI: 1225373475
Provider Name (Legal Business Name): NEW BEGINNING THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S WAVERLY RD STE 4
LANSING MI
48917-3632
US

IV. Provider business mailing address

420 S WAVERLY RD STE 4
LANSING MI
48917-3632
US

V. Phone/Fax

Practice location:
  • Phone: 517-708-8215
  • Fax: 517-708-8223
Mailing address:
  • Phone: 517-708-8215
  • Fax: 517-708-8223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085790
License Number StateMI

VIII. Authorized Official

Name: MRS. KATHY SAMIR CHEBLI
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW
Phone: 517-708-8215