=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245191485
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSIGHT & INTEGRATION THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2025
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14800 FARMINGTON RD STE 109
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48154-5464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-530-4656
-----------------------------------------------------
Fax | 313-539-8921
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14800 FARMINGTON RD STE 109
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48154-5464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-530-4656
-----------------------------------------------------
Fax | 313-539-8921
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAIME LYNN SUTHERLAND
-----------------------------------------------------
Credential | MS, LLP, CAADC
-----------------------------------------------------
Telephone | 313-530-4656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------