=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538902333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAILY REPRIEVE COUNSELING AND MENTAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2024
-----------------------------------------------------
Last Update Date | 12/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5340 PLYMOUTH RD STE 104
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105-9557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-433-8922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5340 PLYMOUTH RD STE 104
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105-9557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-433-8922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHAEL MEZA
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 734-433-8922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------