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General NPI Number Information
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NPI Number | 1053024737
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Entity Type | Organization
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Legal Business Name | ALPHA MIND & MUSCLE
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 43643 CEDARHURST DR
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City | VAN BUREN TWP
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State | MI
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Zip | 48111-4573
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Country | US
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Telephone | 734-318-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 43643 CEDARHURST DR
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City | VAN BUREN TWP
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State | MI
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Zip | 48111-4573
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Country | US
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Telephone | 734-318-1999
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Fax |
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Authorized Official
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Title or Position | MASTER LEVEL COUNSELOR
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Name | JOY MONTGOMERY
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Credential | MS, MA, LPC
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Telephone | 734-318-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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