Provider Demographics
NPI:1972115194
Name:TINY FEET WELLNESS
Entity Type:Organization
Organization Name:TINY FEET WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-231-5298
Mailing Address - Street 1:41570 HAYES RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5819
Mailing Address - Country:US
Mailing Address - Phone:586-231-5298
Mailing Address - Fax:
Practice Address - Street 1:41570 HAYES RD STE C
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5819
Practice Address - Country:US
Practice Address - Phone:586-231-5298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty