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General NPI Number Information
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NPI Number | 1548644990
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Entity Type | Individual
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Provider Name | HEATHER RYLANCE LPCI
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Gender | Female
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 280 N OLD WOODWARD AVE STE LL4
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City | BIRMINGHAM
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State | MI
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Zip | 48009-5324
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Country | US
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Telephone | 248-206-5886
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Fax |
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Provider Business Mailing Address
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Address Line | 1629 SPOTSWOOD DR
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City | BLOOMFIELD TOWNSHIP
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State | MI
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Zip | 48302-2267
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Country | US
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Telephone | 248-225-1781
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6063
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401222707
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License Number State | MI
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