=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063059343
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNMASKING THE FEAR COUNSELING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2019
-----------------------------------------------------
Last Update Date | 12/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9341 N HAGGERTY RD
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48170-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-570-0636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9341 N HAGGERTY RD
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48170-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-570-0636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | ELIZABETH CARRINGTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-570-0636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------