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General NPI Number Information
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NPI Number | 1295129799
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Entity Type | Organization
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Legal Business Name | THERASUPPORT, LLC
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 4343 CONCOURSE DR. SUITE 250
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City | ANN ARBOR
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State | MI
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Zip | 48108-8672
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Country | US
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Telephone | 734-677-0200
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Fax | 734-677-3310
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Provider Business Mailing Address
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Address Line | 4343 CONCOURSE DR. SUITE 250
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City | ANN ARBOR
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State | MI
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Zip | 48108-8672
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Country | US
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Telephone | 734-677-0200
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Fax | 734-677-3310
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CHRISTY L DELPH
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Credential |
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Telephone | 734-677-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5201007359
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101001686
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301001432
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License Number State | MI
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