Prominent Life Changes Therapy Group. P.C.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PROMINENT LIFE CHANGES THERAPY GROUP. P.C.

Practice address

2844 Livernois Road
Unit 1434
Troy, MI 48099

Phone

(586) 942-1430

NPI assigned

Dec 16, 2021

Organization subpart

No

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

Authorized official

Name

Wendy Vaughter, LLMSWNPI 1417419318

Title

Clinical Social Worker

Phone

(586) 942-1430

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

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

• Wendy Vaughter, MPA,LLMSW, DP-C

  • Clinical Social Worker
  • Troy, MI
  • NPI 1417419318
  NPD Authorized official

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

{
    "created_epoch": "1639612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1326707399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1434",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48099",
            "telephone_number": "586-942-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2844 LIVERNOIS ROAD",
            "address_2": "UNIT 1434",
            "city": "TROY",
            "state": "MI",
            "postal_code": "48099",
            "telephone_number": "586-942-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMINENT LIFE CHANGES THERAPY GROUP. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-16",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "VAUGHTER",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "586-942-1430",
        "authorized_official_credential": "LLMSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417419318",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "prominentc@zohomail.com",
            "affiliation": "N",
            "endpointDescription": "prominentc@zohomail.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2844 Livernois Road",
            "address_2": "Unit 1434",
            "city": "Troy",
            "state": "MI",
            "country_code": "US",
            "postal_code": "48099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.