Healthcare Provider Details

I. General information

NPI: 1457275992
Provider Name (Legal Business Name): MAITRI MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

586 RIVER OAKS DR
MILFORD MI
48381-1039
US

IV. Provider business mailing address

586 RIVER OAKS DR
MILFORD MI
48381-1039
US

V. Phone/Fax

Practice location:
  • Phone: 865-274-7672
  • Fax:
Mailing address:
  • Phone: 865-274-7672
  • 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: ELIZABETH D CAMPBELL
Title or Position: OWNER
Credential: LMFT
Phone: 865-274-7672