Healthcare Provider Details

I. General information

NPI: 1710751268
Provider Name (Legal Business Name): URBANISTIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 W 10 MILE RD STE 211-1343
SOUTHFIELD MI
48075-2079
US

IV. Provider business mailing address

15900 W 10 MILE RD STE 211
SOUTHFIELD MI
48075-2079
US

V. Phone/Fax

Practice location:
  • Phone: 313-424-3978
  • Fax:
Mailing address:
  • Phone: 313-424-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ERICKA MAGEE
Title or Position: CLINICAL THERAPIST
Credential: LMSW
Phone: 313-424-3978