| NPI | 1477152445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA SHORT-SLACK Owner 810-429-7359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 106H00000X Marriage & Family Therapist | |
| 225700000X Massage Therapist | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2022-12-12 |