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General NPI Number Information
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NPI Number | 1639770290
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Entity Type | Organization
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Legal Business Name | PURE JOURNEY COUNSELING
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 2820 W MAPLE RD STE 100
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City | TROY
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State | MI
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Zip | 48084-7064
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Country | US
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Telephone | 248-225-3769
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Fax |
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Provider Business Mailing Address
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Address Line | 2820 W MAPLE RD STE 100
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City | TROY
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State | MI
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Zip | 48084-7064
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Country | US
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Telephone | 248-225-3769
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | MS. MASOUMEH MORADI
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Credential | LPC
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Telephone | 248-225-3769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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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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