Heal Thyself Therapeutics, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

HEAL THYSELF THERAPEUTICS, LLC

Practice address

1100 Corporate Office Dr Ste 320
Milford, MI 48381-5002

Phone

(810) 434-7933

NPI assigned

Nov 20, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Derrick Jerome Jackson II, LMSWNPI 1588928626

Title

Therapist

Phone

(810) 434-7933

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derrick Jerome Jackson, LLMSW

  • Clinical Social Worker
  • Pontiac, MI
  • NPI 1588928626
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1003419136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34326 SHERIDAN ST",
            "city": "WESTLAND",
            "state": "MI",
            "postal_code": "481858511",
            "telephone_number": "810-434-7933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 CORPORATE OFFICE DR STE 320",
            "city": "MILFORD",
            "state": "MI",
            "postal_code": "483815002",
            "telephone_number": "810-434-7933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAL THYSELF THERAPEUTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-20",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "810-434-7933",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dave Hammond
• Bethany Diane Hampton-Green, COTA
• Harvey Lefkowitz, D.P.M., P.C.
• Shelby Harvey, ATC
• Kaitlyn Hawke
• Health Sense Pharmacy and Food Company LLC
• Hearts and Hands Home Health Care LLC
• Maureen Patricia Heathman
• Thomas Hein
• Heinsight Optical Inc

• Clinical Social Worker in Milford, MI
• Providers in Milford, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.