Organization · NPI-2

Black Male Therapist LLC

Clinic/Center, Mental Health (Including Community Mental Health Center) · Southfield, MI

NPI number1194317248
StatusActive
Last updated in NPPESFeb 10, 2021

Details

NPI
1194317248
Entity type
Organization (NPI-2)
Legal business name
Black Male Therapist LLC
Organization subpart
No
Enumeration date
Feb 10, 2021
Certification date
Feb 10, 2021
Last updated
Feb 10, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes

Practice location

21650 W 11 Mile Rd Ste 108
Southfield, MI 48076-3715

Phone 248-973-7177

Mailing address

21650 W 11 Mile Rd Ste 108
Southfield, MI 48076-3715

Phone 248-973-7177

Authorized official

Steven D Stuckey
Owner
2489737177

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