Provider Demographics
NPI:1578327714
Name:MISSELAINEOUS THERAPY SERVICES
Entity Type:Organization
Organization Name:MISSELAINEOUS THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSHOT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:817-690-3326
Mailing Address - Street 1:1906 ALMONT ST
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2072
Mailing Address - Country:US
Mailing Address - Phone:817-690-3326
Mailing Address - Fax:
Practice Address - Street 1:5777 W MAPLE RD STE 177
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2306
Practice Address - Country:US
Practice Address - Phone:216-206-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty