1043735319 NPI number — CATALYST COUNSELING AND CONSULTING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043735319 NPI number — CATALYST COUNSELING AND CONSULTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATALYST COUNSELING AND CONSULTING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043735319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3904 CLOVERLAWN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48197-8611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 PEARL ST STE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197-2663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-606-9802
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
ROSIE
Authorized Official Middle Name:
MISHELLE
Authorized Official Title or Position:
OWNER, PSYCHOLOGIST
Authorized Official Telephone Number:
734-606-9802

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  6301016377 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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