Healthcare Provider Details

I. General information

NPI: 1114607199
Provider Name (Legal Business Name): MIND REFRESH COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W BIG BEAVER RD SUITE 300
TROY MI
48084-2801
US

IV. Provider business mailing address

801 W BIG BEAVER RD STE 300
TROY MI
48084-4725
US

V. Phone/Fax

Practice location:
  • Phone: 248-658-8424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY T BOND
Title or Position: OWNER/CLINICAL THERAPIST
Credential: LPC
Phone: 248-658-8424