1720557093 NPI number — BLOOMFIELD CHILD & FAMILY COUNSELING PLLC

Table of content: (NPI 1720557093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720557093 NPI number — BLOOMFIELD CHILD & FAMILY COUNSELING PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOMFIELD CHILD & FAMILY COUNSELING PLLC
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1720557093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7451 WELLBOURNE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48301-3766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-256-0896
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3290 W BIG BEAVER RD STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-238-8702
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CORTEZ
Authorized Official First Name:
JESSICA
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
248-457-5178

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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