Provider Demographics
NPI:1316563950
Name:ENGEDI THERAPY LLC
Entity Type:Organization
Organization Name:ENGEDI THERAPY LLC
Other - Org Name:ENGEDI THERAPY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:KYRIE
Authorized Official - Last Name:BROWN-GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, MA
Authorized Official - Phone:248-914-4607
Mailing Address - Street 1:30100 TELEGRAPH RD STE 474
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5810
Mailing Address - Country:US
Mailing Address - Phone:248-914-4607
Mailing Address - Fax:313-977-9296
Practice Address - Street 1:30100 TELEGRAPH RD STE 474
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-5810
Practice Address - Country:US
Practice Address - Phone:248-914-4607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty