Provider Demographics
NPI:1346745601
Name:4 DEGREES INTEGRATIVE THERAPY AND CONSULTING, PLLC
Entity Type:Organization
Organization Name:4 DEGREES INTEGRATIVE THERAPY AND CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-328-3399
Mailing Address - Street 1:6140 HARDY AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-1560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 E ELLIS RD # 563
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5646
Practice Address - Country:US
Practice Address - Phone:231-799-4929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty