Healthcare Provider Details

I. General information

NPI: 1366055212
Provider Name (Legal Business Name): LETS TALK THERAPY PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W BIG BEAVER RD STE 780
TROY MI
48084-4745
US

IV. Provider business mailing address

1221 BOWERS ST UNIT 89
BIRMINGHAM MI
48012-7111
US

V. Phone/Fax

Practice location:
  • Phone: 248-907-0775
  • Fax:
Mailing address:
  • Phone: 248-763-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: LORI BONDALAPATI
Title or Position: CEO
Credential: MA, LPC, CAADC
Phone: 248-763-8536