Healthcare Provider Details

I. General information

NPI: 1225464068
Provider Name (Legal Business Name): JUANITA TOOKES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38600 VAN DYKE AVE STE 101
STERLING HEIGHTS MI
48312-1171
US

IV. Provider business mailing address

44899 CENTRE CT STE. 101
CLINTON TOWNSHIP MI
48038-5510
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax: 248-605-3525
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number6301015607
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401016023
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: