MEDICARE: OUT OF MIND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538502299	OTHER	AZ	COUNCIL FOR AFFORDABLE QUALITY HEALTHCARE

General Provider Information

NPI Number	:	1134684061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUT OF MIND

Provider Business Mailing Address
First Line	:	17649 KINGSBROOKE CIR APT 101
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-3789
Country	:	US
Telephone Number	:	313-522-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	39200 GARFIELD RD STE C
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-4095
Country	:	US
Telephone Number	:	313-522-2520
Fax Number	:

Authorized Official
Title or Position	:	PROFESSIONAL COUNSELOR
Name	:	MS. RENISHA DANIELLE SIMPKINS
Credential	:	MA,LPC,NCC
Telephone Number	:	313-522-2520

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	01/24/2025

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Directions to “OUT OF MIND ” Practice Location

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