Provider Demographics
NPI:1831699818
Name:INTENTIONAL ENERGY THERAPY, PLLC
Entity type:Organization
Organization Name:INTENTIONAL ENERGY THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S, NCC
Authorized Official - Phone:734-904-5031
Mailing Address - Street 1:135 WESTBROOK
Mailing Address - Street 2:
Mailing Address - City:WHITMORE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48189-8208
Mailing Address - Country:US
Mailing Address - Phone:734-904-5031
Mailing Address - Fax:734-402-8928
Practice Address - Street 1:211 N 1ST ST STE 273
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1297
Practice Address - Country:US
Practice Address - Phone:734-904-5031
Practice Address - Fax:734-402-8928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty