Provider Demographics
NPI:1720685464
Name:THIERA DANYAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:THIERA DANYAL THERAPY AND WELLNESS LLC
Other - Org Name:CLIFFORD COPING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THIERA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:313-800-2497
Mailing Address - Street 1:1771 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6645
Mailing Address - Country:US
Mailing Address - Phone:313-800-2497
Mailing Address - Fax:
Practice Address - Street 1:1771 S GROVE ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6645
Practice Address - Country:US
Practice Address - Phone:313-800-2497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285013979Medicaid