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General NPI Number Information
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NPI Number | 1831699818
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Entity Type | Organization
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Legal Business Name | INTENTIONAL ENERGY THERAPY, PLLC
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 211 N 1ST ST STE 273
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City | BRIGHTON
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State | MI
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Zip | 48116-1297
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Country | US
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Telephone | 734-904-5031
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Fax | 734-402-8928
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Provider Business Mailing Address
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Address Line | 135 WESTBROOK
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City | WHITMORE LAKE
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State | MI
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Zip | 48189-8208
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Country | US
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Telephone | 734-904-5031
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Fax | 734-402-8928
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. REBECCA R MAKOWSKI
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Credential | MA, LPC-S, NCC
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Telephone | 734-904-5031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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