Healthcare Provider Details

I. General information

NPI: 1922862143
Provider Name (Legal Business Name): MELIORA THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 HURON AVE STE C
PORT HURON MI
48060-3842
US

IV. Provider business mailing address

2503 ARMOUR ST
PORT HURON MI
48060-2904
US

V. Phone/Fax

Practice location:
  • Phone: 810-771-8457
  • Fax:
Mailing address:
  • Phone: 616-805-6740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JAMIE MCHALE
Title or Position: OWNER
Credential: LLMSW
Phone: 810-771-8457