Healthcare Provider Details

I. General information

NPI: 1639707714
Provider Name (Legal Business Name): ALLAY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 W SAINT CLAIR ST
ROMEO MI
48065-4657
US

IV. Provider business mailing address

66773 CAMPGROUND RD
WASHINGTON TOWNSHIP MI
48095-1854
US

V. Phone/Fax

Practice location:
  • Phone: 248-410-1559
  • 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 Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW TAROCKOFF
Title or Position: MEMBER/OWNER
Credential:
Phone: 248-410-1559