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General NPI Number Information
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NPI Number | 1942725718
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Entity Type | Organization
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Legal Business Name | THERAPY INSTITUTE OF MICHIGAN LLC
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Dates
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Enumeration Date | 08/13/2017
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 1 HERITAGE DR STE 220
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City | SOUTHGATE
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State | MI
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Zip | 48195-3048
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Country | US
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Telephone | 734-672-0068
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Fax | 734-672-0068
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Provider Business Mailing Address
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Address Line | 1 HERITAGE DR STE 220
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City | SOUTHGATE
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State | MI
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Zip | 48195-3048
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Country | US
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Telephone | 734-672-0068
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Fax | 734-250-7864
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | KIMBERLY-ANN BLAIR MCFARLAND
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Credential | MS, LPC, NCC
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Telephone | 734-672-0068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 6401014309
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License Number State | MI
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