Healthcare Provider Details

I. General information

NPI: 1922772995
Provider Name (Legal Business Name): IT'S TIME COUNSELING AND LIFE COACH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W BIG BEAVER RD
TROY MI
48084-4736
US

IV. Provider business mailing address

319 S MARSHALL ST
PONTIAC MI
48342-3248
US

V. Phone/Fax

Practice location:
  • Phone: 313-266-0374
  • Fax:
Mailing address:
  • Phone: 313-266-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTEN TAYLOR
Title or Position: OWNER/LEAD COUNSELOR
Credential: LPC
Phone: 313-266-0374