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General NPI Number Information
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NPI Number | 1316341175
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Entity Type | Individual
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Provider Name | MICHAEL DESMARAIS LPC
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Gender | Male
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 42669 GARFIELD RD
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City | CLINTON TWP
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State | MI
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Zip | 48038
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Country | US
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Telephone | 586-412-5321
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Fax | 586-412-5327
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Provider Business Mailing Address
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Address Line | 6549 TOWN CENTER DR STE. A
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City | CLARKSTON
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State | MI
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Zip | 48346-4824
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Country | US
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Telephone | 248-620-6400
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Fax | 248-620-6405
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401014521
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401014521
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License Number State | MI
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