Healthcare Provider Details

I. General information

NPI: 1992624662
Provider Name (Legal Business Name): MIND TECH THERAPY AND WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 OKEMOS RD
OKEMOS MI
48864-1663
US

IV. Provider business mailing address

4747 OKEMOS RD
OKEMOS MI
48864-1663
US

V. Phone/Fax

Practice location:
  • Phone: 517-667-8175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DARYLANNE PEARSON
Title or Position: CREDENTIALING
Credential:
Phone: 517-740-4098