Provider Demographics
NPI:1407107154
Name:FAMILY THERAPY AND RECOVERY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FAMILY THERAPY AND RECOVERY ASSOCIATES, LLC
Other - Org Name:FTRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAADC
Authorized Official - Phone:248-760-2672
Mailing Address - Street 1:217 KNOWLES ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2767
Mailing Address - Country:US
Mailing Address - Phone:248-760-2672
Mailing Address - Fax:
Practice Address - Street 1:217 KNOWLES ST
Practice Address - Street 2:SUITE 260
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2767
Practice Address - Country:US
Practice Address - Phone:248-760-2672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010170271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316046220OtherNPI-1