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General NPI Number Information
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NPI Number | 1730682253
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Entity Type | Organization
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Legal Business Name | ENVISION WELLNESS LLC
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Dates
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Enumeration Date | 03/11/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 26677 W 12 MILE RD STE 136
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1514
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Country | US
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Telephone | 248-990-6384
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Fax |
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Provider Business Mailing Address
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Address Line | 26677 W 12 MILE RD STE 136
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1514
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Country | US
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Telephone | 248-990-6384
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. ALTHEA D SMITH
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Credential | MENTAL HEALTH COUNSE
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Telephone | 248-990-6384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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