Healthcare Provider Details

I. General information

NPI: 1174480008
Provider Name (Legal Business Name): PREMIER THERAPY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18119 RED OAKS DR
MACOMB MI
48044-2776
US

IV. Provider business mailing address

18119 RED OAKS DR
MACOMB MI
48044-2776
US

V. Phone/Fax

Practice location:
  • Phone: 734-748-4826
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: TARA SHEPARD
Title or Position: OWNER/THERAPIST
Credential: LLP
Phone: 734-748-4826