=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992569727
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CURATED CHANGE PSYCHOTHERAPY AND COACHING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2024
-----------------------------------------------------
Last Update Date | 03/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2222 W GRAND RIVER AVE STE A
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-247-2033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2222 W GRAND RIVER AVE STE A
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-247-2033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER, CEO, AND THERAPIST
-----------------------------------------------------
Name | INCIA AAMIR RASHID
-----------------------------------------------------
Credential | MA, LPC
-----------------------------------------------------
Telephone | 312-468-7537
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------