Provider Demographics
NPI:1942725718
Name:THERAPY INSTITUTE OF MICHIGAN LLC
Entity Type:Organization
Organization Name:THERAPY INSTITUTE OF MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY-ANN
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:734-672-0068
Mailing Address - Street 1:1 HERITAGE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3048
Mailing Address - Country:US
Mailing Address - Phone:734-672-0068
Mailing Address - Fax:734-250-7864
Practice Address - Street 1:1 HERITAGE DR STE 220
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3048
Practice Address - Country:US
Practice Address - Phone:734-672-0068
Practice Address - Fax:734-672-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014309261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)