Provider Demographics
NPI:1881462984
Name:ORIGINS THERAPY PLLC
Entity type:Organization
Organization Name:ORIGINS THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ISABELLE
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-974-9875
Mailing Address - Street 1:18980 SANTA BARBARA DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2152
Mailing Address - Country:US
Mailing Address - Phone:313-974-9875
Mailing Address - Fax:
Practice Address - Street 1:18980 SANTA BARBARA DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2152
Practice Address - Country:US
Practice Address - Phone:313-974-9875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health