Healthcare Provider Details

I. General information

NPI: 1730826462
Provider Name (Legal Business Name): JASON RICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 TELEGRAPH RD STE 200
TAYLOR MI
48180-3386
US

IV. Provider business mailing address

23332 FARMINGTON RD # 208
FARMINGTON MI
48336-9991
US

V. Phone/Fax

Practice location:
  • Phone: 313-406-4493
  • Fax:
Mailing address:
  • Phone: 313-992-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451022812
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: