Healthcare Provider Details

I. General information

NPI: 1841972742
Provider Name (Legal Business Name): SIMPLY BEGIN AGAIN THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30508 HOY ST
LIVONIA MI
48154-3654
US

IV. Provider business mailing address

30508 HOY ST
LIVONIA MI
48154-3654
US

V. Phone/Fax

Practice location:
  • Phone: 734-732-6295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATIE TIBBLES
Title or Position: THERAPIST
Credential: LPC, LCMHC
Phone: 734-732-6295