Provider Demographics
NPI:1699408674
Name:EMERGE THERAPY, PLC
Entity Type:Organization
Organization Name:EMERGE THERAPY, PLC
Other - Org Name:EMERGE TELETHERAPY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-945-2095
Mailing Address - Street 1:17145 BONSTELLE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3470
Mailing Address - Country:US
Mailing Address - Phone:248-996-4917
Mailing Address - Fax:
Practice Address - Street 1:17145 BONSTELLE AVE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3470
Practice Address - Country:US
Practice Address - Phone:248-945-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health