Healthcare Provider Details

I. General information

NPI: 1427794528
Provider Name (Legal Business Name): MINDFLEX THERAPIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
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

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

V. Phone/Fax

Practice location:
  • Phone: 248-513-8074
  • Fax: 248-468-7094
Mailing address:
  • Phone: 248-513-8074
  • Fax: 248-468-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LAMERATO
Title or Position: OWNER
Credential:
Phone: 248-513-8074