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General NPI Number Information
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NPI Number | 1578327714
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Entity Type | Organization
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Legal Business Name | MISSELAINEOUS THERAPY SERVICES
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 5777 W MAPLE RD STE 177
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-2306
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Country | US
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Telephone | 216-206-7313
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 ALMONT ST
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City | FERNDALE
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State | MI
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Zip | 48220-2072
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Country | US
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Telephone | 817-690-3326
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | ELAINE HENDERSHOT
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Credential | LMSW
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Telephone | 817-690-3326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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