Healthcare Provider Details

I. General information

NPI: 1003522061
Provider Name (Legal Business Name): MICHIGAN INTEGRATED THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 MOORSBRIDGE RD STE 102
PORTAGE MI
49024-4422
US

IV. Provider business mailing address

8080 MOORSBRIDGE RD STE 102
PORTAGE MI
49024-4422
US

V. Phone/Fax

Practice location:
  • Phone: 269-795-6681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY NAUMANN
Title or Position: OFFICE MANAGER
Credential:
Phone: 269-795-6681