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General NPI Number Information
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NPI Number | 1235645847
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Entity Type | Organization
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Legal Business Name | ENCOMPASS THERAPY CENTER, LLC
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 3710 KATALIN CT
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City | BAY CITY
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State | MI
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Zip | 48706-2160
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Country | US
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Telephone | 989-324-8924
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Fax |
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Provider Business Mailing Address
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Address Line | 3710 KATALIN CT
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City | BAY CITY
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State | MI
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Zip | 48706-2160
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Country | US
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Telephone | 989-324-8924
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MRS. ASHLEY NICOLE BLAKE
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Credential | M.S., BCBA
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Telephone | 989-324-8924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-14-17456
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License Number State | MI
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