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General NPI Number Information
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NPI Number | 1134684061
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Entity Type | Organization
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Legal Business Name | OUT OF MIND
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 39200 GARFIELD RD STE C
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-4095
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Country | US
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Telephone | 313-522-2520
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Fax |
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Provider Business Mailing Address
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Address Line | 17649 KINGSBROOKE CIR APT 101
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-3789
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Country | US
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Telephone | 313-522-5220
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | MS. RENISHA DANIELLE SIMPKINS
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Credential | MA,LPC,NCC
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Telephone | 313-522-2520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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