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General NPI Number Information
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NPI Number | 1316639297
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Entity Type | Organization
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Legal Business Name | MYSELFINCLUDED
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 15140 LIVERNOIS AVE
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City | DETROIT
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State | MI
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Zip | 48238-2045
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Country | US
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Telephone | 248-459-2147
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Fax |
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Provider Business Mailing Address
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Address Line | 14123 SHAMROCK DR
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City | REDFORD
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State | MI
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Zip | 48239-2995
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Country | US
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Telephone | 248-459-2147
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA B BURGESS
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Credential | LMSW
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Telephone | 248-459-2147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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