Provider Demographics
NPI:1205028008
Name:LIFEWORK FAMILY & TRAUMA COUNSELING PC
Entity Type:Organization
Organization Name:LIFEWORK FAMILY & TRAUMA COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLOUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:248-283-1107
Mailing Address - Street 1:725 S ADAMS RD
Mailing Address - Street 2:SUITE L 136
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6902
Mailing Address - Country:US
Mailing Address - Phone:248-283-1107
Mailing Address - Fax:248-723-6646
Practice Address - Street 1:725 S ADAMS RD
Practice Address - Street 2:SUITE L 136
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6902
Practice Address - Country:US
Practice Address - Phone:248-283-1107
Practice Address - Fax:248-723-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003903101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA878123OtherVALUE OPTIONS