=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952246589
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMOTIONAL SUPPORT QUEER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2026
-----------------------------------------------------
Last Update Date | 04/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7356 E BROOK DR
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-9267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-492-5424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7356 E BROOK DR
-----------------------------------------------------
City | YPSILANTI
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48197-9267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | JESSICA MILLER MILLER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 734-492-5424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------