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General NPI Number Information
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NPI Number | 1770340366
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Entity Type | Organization
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Legal Business Name | J&P COUSINS LLC
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Dates
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Enumeration Date | 03/01/2024
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 21040 GREENFIELD RD
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City | OAK PARK
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State | MI
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Zip | 48237-3025
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Country | US
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Telephone | 248-951-8413
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Fax | 248-951-8420
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Provider Business Mailing Address
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Address Line | 18082 PARKSIDE ST
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City | DETROIT
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State | MI
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Zip | 48221-2719
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Country | US
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Telephone | 313-402-9608
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. AUDREY ELAINE SMITH
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Credential | MPH
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Telephone | 313-402-9608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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