Healthcare Provider Details

I. General information

NPI: 1073429296
Provider Name (Legal Business Name): COLLEEN ERIN BACH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 CHERRY DR
TROY MI
48083-1612
US

IV. Provider business mailing address

4201 BLACKBURN DR
WEST BLOOMFIELD MI
48323-3075
US

V. Phone/Fax

Practice location:
  • Phone: 248-924-1732
  • Fax:
Mailing address:
  • Phone: 248-924-1732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801117586
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: