Healthcare Provider Details

I. General information

NPI: 1669752218
Provider Name (Legal Business Name): COUNSELING AND THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 TELEGRAPH RD SUITE 200
TAYLOR MI
48180-3386
US

IV. Provider business mailing address

9333 TELEGRAPH RD SUITE 200
TAYLOR MI
48180-3386
US

V. Phone/Fax

Practice location:
  • Phone: 313-406-4493
  • Fax: 313-406-5609
Mailing address:
  • Phone: 313-406-4493
  • Fax: 313-406-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number04071M
License Number StateMI

VIII. Authorized Official

Name: DAVID R WRIGHT
Title or Position: OPERATIONS MANAGER
Credential: MA, PLC
Phone: 313-406-4493