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General NPI Number Information
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NPI Number | 1083397962
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Entity Type | Organization
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Legal Business Name | BREATHE THERAPY LLC
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 2311 SHELBY AVE APT 106-D
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City | ANN ARBOR
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State | MI
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Zip | 48103-3849
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Country | US
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Telephone | 269-930-4112
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Fax |
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Provider Business Mailing Address
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Address Line | 2311 SHELBY AVE APT 106-D
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City | ANN ARBOR
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State | MI
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Zip | 48103-3849
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Country | US
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Telephone | 269-930-4112
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Fax |
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Authorized Official
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Title or Position | LICENSED MASTERS IN SOCIAL WORK
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Name | STEPHANIE STARKS
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Credential |
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Telephone | 269-930-4112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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