| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 30508 Hoy St, Livonia, Michigan |
| Authorized Official Name and Position | Katie Tibbles (THERAPIST) |
| Authorized Official Contact | 7347326295 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
30508 Hoy St Livonia MI 48154-3654 Ph: () - | 30508 Hoy St Livonia MI 48154-3654 Ph: (734) 732-6295 |
| NPI Number | 1841972742 |
|---|---|
| Provider Enumeration Date | 08/01/2023 |
| Last Update Date | 08/02/2023 |
| Certification Date | 08/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841972742 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
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