Provider Demographics
NPI:1497517288
Name:ROSE OAK MENTAL HEALTH PLLC
Entity Type:Organization
Organization Name:ROSE OAK MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:ERNESTINE
Authorized Official - Last Name:REIKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-996-5544
Mailing Address - Street 1:11308 AUTUMN BREEZE TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1592
Mailing Address - Country:US
Mailing Address - Phone:989-996-5544
Mailing Address - Fax:
Practice Address - Street 1:11308 AUTUMN BREEZE TRL STE 1
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1592
Practice Address - Country:US
Practice Address - Phone:989-996-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty