Provider Demographics
NPI:1598771982
Name:NORTHWEST COUNSELING & PSYCOTHERAPY CENTER
Entity Type:Organization
Organization Name:NORTHWEST COUNSELING & PSYCOTHERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-357-3347
Mailing Address - Street 1:28336 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5503
Mailing Address - Country:US
Mailing Address - Phone:248-357-3347
Mailing Address - Fax:248-357-4447
Practice Address - Street 1:28336 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5503
Practice Address - Country:US
Practice Address - Phone:248-357-3347
Practice Address - Fax:248-357-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICC0116001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509107710OtherBCBS