=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801541974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACE & WELLNESS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2022
-----------------------------------------------------
Last Update Date | 02/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3101 ROCHESTER RD
-----------------------------------------------------
City | ROYAL OAK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48073-3548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-928-4955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3101 ROCHESTER RD
-----------------------------------------------------
City | ROYAL OAK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48073-3548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-928-4955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LPC
-----------------------------------------------------
Name | SHERI GALENS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-928-4955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------