=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003631789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLIVER LEE CONSULTING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2024
-----------------------------------------------------
Last Update Date | 11/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7355 LEWIS AVE STE C
-----------------------------------------------------
City | TEMPERANCE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48182-1465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-224-3761
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7250 DOUGLAS RD
-----------------------------------------------------
City | LAMBERTVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48144-9488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-652-6782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HEATHER FREDERICK
-----------------------------------------------------
Credential | LPC, CAADC, CCS
-----------------------------------------------------
Telephone | 734-224-3761
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------