MEDICARE: MICHIGAN CENTER FOR TRAUMATIC STRESS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163W00000X	Registered Nurse
2	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician
3	163WP0808X	Psychiatric/Mental Health Registered Nurse
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1518591932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN CENTER FOR TRAUMATIC STRESS

Provider Business Mailing Address
First Line	:	21611 E 11 MILE RD
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1636
Country	:	US
Telephone Number	:	586-944-2902
Fax Number	:

Provider Business Practice Location Address
First Line	:	21611 E 11 MILE RD
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-1636
Country	:	US
Telephone Number	:	586-944-2902
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PSYCHOTHERAPIST
Name	:	SYLVIA JOHNSON
Credential	:	LMSW
Telephone Number	:	248-330-5770

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	05/06/2026

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Directions to “MICHIGAN CENTER FOR TRAUMATIC STRESS ” Practice Location

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