Healthcare Provider Details

I. General information

NPI: 1821703844
Provider Name (Legal Business Name): PHASE MENTAL HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
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: 248-406-6756
  • Fax:
Mailing address:
  • Phone: 248-406-6756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY GODBOUT
Title or Position: FOUNDER
Credential: LMSW-C
Phone: 248-245-0665