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General NPI Number Information
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NPI Number | 1023423985
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Entity Type | Organization
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Legal Business Name | PURE REFLECTIONS COUNSELING CENTER
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 17344 W 12 MILE RD SUITE 104
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2121
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Country | US
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Telephone | 810-515-6649
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Fax |
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Provider Business Mailing Address
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Address Line | 17344 W 12 MILE RD SUITE 104
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2121
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRIVATE PRACTITIONER
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Name | MRS. NAKIA NELSON
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Credential |
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Telephone | 810-515-6649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801084249
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License Number State | MI
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