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General NPI Number Information
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NPI Number | 1477061281
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Entity Type | Individual
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Provider Name | ROXANE MINKUS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 2109 HAMILTON RD STE 201
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City | OKEMOS
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State | MI
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Zip | 48864-1700
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Country | US
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Telephone | 517-489-2309
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Fax |
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Provider Business Mailing Address
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Address Line | 1518 HASLETT RD UNIT 98
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City | HASLETT
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State | MI
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Zip | 48840-5503
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Country | US
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Telephone | 517-489-2309
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-22132
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 43621
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401015121
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License Number State | MI
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