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General NPI Number Information
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NPI Number | 1427794528
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Entity Type | Organization
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Legal Business Name | MINDFLEX THERAPIES
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 888 W BIG BEAVER RD STE 780
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City | TROY
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State | MI
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Zip | 48084-4745
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Country | US
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Telephone | 248-513-8074
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Fax | 248-468-7094
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Provider Business Mailing Address
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Address Line | 888 W BIG BEAVER RD STE 780
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City | TROY
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State | MI
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Zip | 48084-4745
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Country | US
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Telephone | 248-513-8074
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Fax | 248-468-7094
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL LAMERATO
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Credential |
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Telephone | 248-513-8074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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