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General NPI Number Information
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NPI Number | 1679124408
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Entity Type | Organization
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Legal Business Name | MIND MANAGEMENT INSTITUTE INC
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 16250 NORTHLAND DR STE 239
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5206
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Country | US
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Telephone | 313-800-2497
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Fax |
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Provider Business Mailing Address
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Address Line | 11000 W MCNICHOLS RD STE 323
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City | DETROIT
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State | MI
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Zip | 48221-2393
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Country | US
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Telephone | 313-800-2497
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. THIERA DANYAL CLIFFORD
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Credential | LP, LPC
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Telephone | 313-800-2497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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