=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376145524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUTRECK CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2020
-----------------------------------------------------
Last Update Date | 11/12/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7645 FOSDICK RD
-----------------------------------------------------
City | SALINE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48176-9091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-635-7469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7645 FOSDICK RD
-----------------------------------------------------
City | SALINE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48176-9091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-635-7469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | MRS. AMY D SZARAZ
-----------------------------------------------------
Credential | MA LLPC
-----------------------------------------------------
Telephone | 734-635-7469
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------