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General NPI Number Information
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NPI Number | 1942716519
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Entity Type | Organization
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Legal Business Name | RESILIENT HEALING
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 3141 W JEFFERSON AVE
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City | TRENTON
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State | MI
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Zip | 48183-2935
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Country | US
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Telephone | 734-328-2817
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Fax |
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Provider Business Mailing Address
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Address Line | 21719 W RIVER RD
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City | GROSSE ILE
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State | MI
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Zip | 48138-1443
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Country | US
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Telephone | 215-919-7220
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | JENNIFER DE BEAUSSET
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Credential | LPC
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Telephone | 734-328-2817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 6402026422
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 6402026422
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License Number State | MI
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