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General NPI Number Information
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NPI Number | 1912618752
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Entity Type | Organization
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Legal Business Name | BEYOND THE SURFACE COUNSELING & CONSULTING LLC
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 41800 HAYES RD STE 522C
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1876
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Country | US
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Telephone | 586-277-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 37583 CHARTER OAKS BLVD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-4406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | CHASITY SHELTON
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Credential | LMSW
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Telephone | 586-277-8999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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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