Provider Demographics
NPI:1316042088
Name:THERAPEUTIC ALLIANCE, INC
Entity Type:Organization
Organization Name:THERAPEUTIC ALLIANCE, INC
Other - Org Name:THERAPEUTIC ALLIANCE, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:SHARPE
Authorized Official - Last Name:TAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, ACSW, ACCHT
Authorized Official - Phone:248-628-8908
Mailing Address - Street 1:611 N AXFORD ST UNIT 53
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48361-8102
Mailing Address - Country:US
Mailing Address - Phone:248-628-8908
Mailing Address - Fax:248-693-5247
Practice Address - Street 1:25 N. NORTH SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3058
Practice Address - Country:US
Practice Address - Phone:248-628-8908
Practice Address - Fax:248-693-5247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010652461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP13000Medicare PIN
MIP13000001Medicare UPIN