Healthcare Provider Details

I. General information

NPI: 1497671671
Provider Name (Legal Business Name): MICHIGAN CENTER FOR TRAUMATIC STRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21611 E 11 MILE RD
SAINT CLAIR SHORES MI
48081-1636
US

IV. Provider business mailing address

21611 E 11 MILE RD
SAINT CLAIR SHORES MI
48081-1636
US

V. Phone/Fax

Practice location:
  • Phone: 586-944-2902
  • Fax:
Mailing address:
  • Phone: 586-944-2902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SYLVIA ROSE JOHNSON
Title or Position: CEO
Credential:
Phone: 248-330-5770