Healthcare Provider Details

I. General information

NPI: 1003526922
Provider Name (Legal Business Name): MY RELATIONSHIPS PROJECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 07/15/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25600 WOODWARD AVE STE 108
ROYAL OAK MI
48067-0944
US

IV. Provider business mailing address

25600 WOODWARD AVE STE 108
ROYAL OAK MI
48067-0944
US

V. Phone/Fax

Practice location:
  • Phone: 614-769-7642
  • Fax:
Mailing address:
  • Phone: 614-769-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATY LEVINSON
Title or Position: OWNER
Credential: LMSW
Phone: 614-769-7642