Basic Information
| Provider Information | |||||||||
| NPI: | 1598771982 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHWEST COUNSELING & PSYCOTHERAPY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28336 FRANKLIN RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480345503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483573347 | ||||||||
| FaxNumber: | 2483574447 | ||||||||
| Practice Location | |||||||||
| Address1: | 28336 FRANKLIN RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480345503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483573347 | ||||||||
| FaxNumber: | 2483574447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KEELER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 2483573347 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CC011600 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7509107710 | 01 | MI | BCBS | OTHER |