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General NPI Number Information
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NPI Number | 1497517288
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Entity Type | Organization
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Legal Business Name | ROSE OAK MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 11308 AUTUMN BREEZE TRL STE 1
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City | CLIO
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State | MI
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Zip | 48420-1592
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Country | US
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Telephone | 989-996-5544
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Fax |
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Provider Business Mailing Address
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Address Line | 11308 AUTUMN BREEZE TRL STE 1
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City | CLIO
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State | MI
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Zip | 48420-1592
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Country | US
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Telephone | 989-996-5544
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL THERAPIST
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Name | DESTINY ERNESTINE REIKOWSKY
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Credential | LMSW
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Telephone | 989-996-5544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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