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General NPI Number Information
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NPI Number | 1063090686
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Entity Type | Organization
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Legal Business Name | TRAUMA TREATMENT COLLECTIVE PLLC
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 20411 W 12 MILE RD # SUIE104
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5414
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Country | US
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Telephone | 757-537-1929
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Fax |
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Provider Business Mailing Address
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Address Line | RA - 37 ALELI STREET ROSALEDA DEVELOPMENT II
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 757-537-1929
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NINA KEELER
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Credential | LMFT
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Telephone | 757-537-1929
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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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