Provider Demographics
NPI:1467221630
Name:INVICTUS MENTAL HEALTH COUNSELING PLLC
Entity Type:Organization
Organization Name:INVICTUS MENTAL HEALTH COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:SENTELLE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-583-9819
Mailing Address - Street 1:9605 W HEREFORD DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1875
Mailing Address - Country:US
Mailing Address - Phone:734-583-9819
Mailing Address - Fax:
Practice Address - Street 1:455 E EISENHOWER PKWY STE 300
Practice Address - Street 2:PMB#108
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108
Practice Address - Country:US
Practice Address - Phone:734-583-9819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty