Blaq Therapy
Counselor, Professional in Mattawan, MI. Organization (NPI-2).
NPI number1609646256
StatusActive
Last updated in NPPESJan 4, 2024
Details
- NPI
- 1609646256
- Entity type
- Organization (NPI-2)
- Legal business name
- Blaq Therapy
- Organization subpart
- No
- Enumeration date
- Jan 4, 2024
- Certification date
- Jan 4, 2024
- Last updated
- Jan 4, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | – | – | Yes |
| 101YM0800X | Counselor, Mental Health | – | – | |
| 103TC1900X | Psychologist, Counseling | – | – | |
| 1041C0700X | Social Worker, Clinical | – | – | |
| 163WP0808X | Registered Nurse, Psych/Mental Health | – | – | |
| 2084P0800X | Psychiatry & Neurology, Psychiatry | – | – | |
| 221700000X | Art Therapist | – | – | |
| 225A00000X | Music Therapist | – | – | |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | |
| 364SP0808X | Clinical Nurse Specialist, Psych/Mental Health | – | – |
Practice location
24073 Crescent StMattawan, MI 49071-8457
Phone 734-802-7667
Mailing address
Po Box 714Mattawan, MI 49071-0714
Authorized official
Anter Abdallah
Credentialer
7348027667
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