Basic Information
| Provider Information | |||||||||
| NPI: | 1669752218 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNSELING AND THERAPY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9333 TELEGRAPH RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481803386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134064493 | ||||||||
| FaxNumber: | 3134065609 | ||||||||
| Practice Location | |||||||||
| Address1: | 9333 TELEGRAPH RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481803386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134064493 | ||||||||
| FaxNumber: | 3134065609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2011 | ||||||||
| LastUpdateDate: | 12/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3134064493 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA, PLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 04071M | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling |
ID Information
| ID | Type | State | Issuer | Description | 04071M | 01 | MI | MICHIGAN BUSINESS LICENSE | OTHER |