Provider Demographics
NPI:1255127106
Name:SERENITY SPRINGS COGNITIVE THERAPY LLC
Entity type:Organization
Organization Name:SERENITY SPRINGS COGNITIVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALISON-EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-792-1625
Mailing Address - Street 1:30114 ARDMORE DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2118
Mailing Address - Country:US
Mailing Address - Phone:248-792-1625
Mailing Address - Fax:
Practice Address - Street 1:30114 ARDMORE DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2118
Practice Address - Country:US
Practice Address - Phone:248-792-1625
Practice Address - Fax:000-000-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty