=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285016071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE HELP COUCH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2015
-----------------------------------------------------
Last Update Date | 09/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28555 ORCHARD LAKE RD STE 230
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48334-2974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-442-6824
-----------------------------------------------------
Fax | 248-487-9676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28555 ORCHARD LAKE RD STE 230
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48334-2974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-442-6824
-----------------------------------------------------
Fax | 248-487-9676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANDREA ANDERSON
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 844-442-6824
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6301014329
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------