Provider Demographics
NPI:1609141969
Name:JUDITH A PERSLEY LLC INDIVIDUAL AND FAMILY COUNSELING
Entity Type:Organization
Organization Name:JUDITH A PERSLEY LLC INDIVIDUAL AND FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-872-7215
Mailing Address - Street 1:43117 W KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1224
Mailing Address - Country:US
Mailing Address - Phone:586-872-7215
Mailing Address - Fax:
Practice Address - Street 1:37040 GARFIELD RD
Practice Address - Street 2:SUITE T-5
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-3646
Practice Address - Country:US
Practice Address - Phone:586-872-7215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089336261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health