Basic Information
| Provider Information | |||||||||
| NPI: | 1730686007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRENZLER | ||||||||
| FirstName: | GRANT | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | MA, LLPC, RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31557 SCHOOLCRAFT RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481501848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344742958 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9333 TELEGRAPH RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481803386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134064493 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 03/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 101YM0800X | 6401018881 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.