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General NPI Number Information
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NPI Number | 1174002018
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Entity Type | Organization
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Legal Business Name | CONFLICT RESOLUTION INSTITUTE
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 2026 AUSTIN DR
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City | NOVI
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State | MI
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Zip | 48377-1906
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Country | US
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Telephone | 248-385-3498
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Fax | 810-213-0555
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Provider Business Mailing Address
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Address Line | 2026 AUSTIN DR
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City | NOVI
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State | MI
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Zip | 48377-1906
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Country | US
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Telephone | 248-385-3498
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Fax | 810-213-0555
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Authorized Official
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Title or Position | COUNSELOR
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Name | TERENCE BROUSSARD-BNU
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Credential |
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Telephone | 248-385-3498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6401016209
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License Number State | MI
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