Healthcare Provider Details

I. General information

NPI: 1699377960
Provider Name (Legal Business Name): FLOURISHING LIVES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 07/28/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30801 JEFFERSON AVE
SAINT CLAIR SHORES MI
48082-1732
US

IV. Provider business mailing address

128 BROOKLET CIR
SAINT MARYS GA
31558-9057
US

V. Phone/Fax

Practice location:
  • Phone: 586-293-1234
  • Fax:
Mailing address:
  • Phone: 219-427-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: GWEN CLAUSSEN
Title or Position: CEO
Credential:
Phone: 219-427-7839