=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598573214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLOURISH THERAPEUTIC SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2024
-----------------------------------------------------
Last Update Date | 12/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6015 ROBIN HL
-----------------------------------------------------
City | WASHINGTON TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48094-2185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-900-1387
-----------------------------------------------------
Fax | 248-983-0723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5682 JEFFERSON RD
-----------------------------------------------------
City | NORTH BRANCH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48461-8550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMSW
-----------------------------------------------------
Name | LINDSAY MARIE BERISHAJ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 586-907-1956
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------