Healthcare Provider Details

I. General information

NPI: 1396315305
Provider Name (Legal Business Name): YPSI ARBOR COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 07/03/2021
Certification Date: 07/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 KINGWOOD ST
YPSILANTI MI
48197-2142
US

IV. Provider business mailing address

9905 S HAZEL ST
SOUTH LYON MI
48178-9007
US

V. Phone/Fax

Practice location:
  • Phone: 734-531-8044
  • Fax:
Mailing address:
  • Phone: 734-531-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAUREN KEOUGH
Title or Position: OWNER
Credential: LMSW
Phone: 734-531-8044