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General NPI Number Information
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NPI Number | 1447504071
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 3554 S CUSTER RD
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City | MONROE
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State | MI
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Zip | 48161-9774
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Country | US
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Telephone | 734-915-6722
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Fax |
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Provider Business Mailing Address
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Address Line | 3826 MCNEIL DRVIE
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City | PETERSBURG
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State | MI
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Zip | 49270-9759
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Country | US
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Telephone | 734-915-6722
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Fax |
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Authorized Official
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Title or Position | MA LPC
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Name | AUDREY L RUMLER
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Credential | MA LPC
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Telephone | 734-915-6722
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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 | 6401007774
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License Number State | MI
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