Provider Demographics
NPI:1568860898
Name:THE SYMMETRY GROUP, LLC
Entity Type:Organization
Organization Name:THE SYMMETRY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRABITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-359-3161
Mailing Address - Street 1:23810 MICHIGAN AVE
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1830
Mailing Address - Country:US
Mailing Address - Phone:313-359-3161
Mailing Address - Fax:313-359-4811
Practice Address - Street 1:23810 MICHIGAN AVE
Practice Address - Street 2:SUITE 202B
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1830
Practice Address - Country:US
Practice Address - Phone:313-359-3161
Practice Address - Fax:313-359-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TC0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI2455Medicare PIN