Profound Psychotherapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

PROFOUND PSYCHOTHERAPY LLC

Practice address

145 S Livernois Rd # 113
Rochester Hills, MI 48307-1837

Phone

(248) 250-0253

NPI assigned

Nov 12, 2020

Last updated

Jan 28, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Azeldri Van Der Wath, LCSWNPI 1366043408

Title

Therapist

Phone

(248) 250-2530

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Azeldri Van Der Wath, LCSW

  • Clinical Social Worker
  • Troy, MI
  • NPI 1366043408
  NPD Authorized official

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

{
    "created_epoch": "1605139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611792000000",
    "number": "1376145557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41423 AMBERCREST DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483143719",
            "telephone_number": "248-250-0253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 S LIVERNOIS RD # 113",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483071837",
            "telephone_number": "248-250-0253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFOUND PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-12",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "VAN DER WATH",
        "authorized_official_first_name": "AZELDRI",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "248-250-2530",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassiann Procenko, LICSW
• Todd B Proctor, MD
• Yvette Proctor, LPN
• Professional Breathing Associates Inc (Professional Breathing Associates)
• Professional Recordkeeping Systems, LLC
• Emalee Jane Prohaska, FNP
• Julian Alexander Prosser, LLMSW
• Victoria Pruss, FNP-BC
• Psi Medical
• Douglas Eugene Pugmire, D.O.

• Clinical Social Worker in Rochester Hills, MI
• Providers in Rochester Hills, 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 Jan 28, 2021; 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.