Supreme Life Wellness PLLC

Primary specialty

Social WorkerTaxonomy code 104100000X

Legal business name

SUPREME LIFE WELLNESS PLLC

Practice address

16970 New Hampshire Dr
Southfield, MI 48075-2905

Phone

(313) 522-4708

NPI assigned

Aug 22, 2023

Organization subpart

No

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

Authorized official

Name

Samantha Trapp, LCSW

Title

Owner

Phone

(313) 522-4708

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1245014232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16970 NEW HAMPSHIRE DR",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752905",
            "telephone_number": "313-522-4708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16970 NEW HAMPSHIRE DR",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752905",
            "telephone_number": "313-522-4708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME LIFE WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-22",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "TRAPP",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-522-4708",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Social Worker in Southfield, MI
• Providers in Southfield, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; 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.