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General NPI Number Information
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NPI Number | 1528808920
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Entity Type | Organization
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Legal Business Name | THERAPY RESILIENCE, PLLC
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 2109 HAMILTON RD STE 202
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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 | 517-420-7362
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Fax |
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Provider Business Mailing Address
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Address Line | 5420 PARK LAKE RD
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City | EAST LANSING
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State | MI
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Zip | 48823-3839
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Country | US
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Telephone | 517-420-7362
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | KENNAN M DEWITT
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Credential | MA, JD, LPC, CAADC
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Telephone | 517-420-7362
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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 |
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License Number State |
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