Blaq Therapy
Organization Active NPI Professional Counselor · Mattawan, MI
NPI 1609646256 · NPPES record last updated Jan 4, 2024
Key facts
- NPI
- 1609646256
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Professional Counselor 101YP2500X
- Legal business name
- BLAQ THERAPY
- Practice address
- 24073 Crescent St
Mattawan, MI 49071-8457 - Phone
- (734) 802-7667
- NPI assigned
- Jan 4, 2024
- Organization subpart
- No
Authorized official
- Name
- Anter Abdallah
- Title
- Credentialer
- Phone
- (734) 802-7667
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Professional Counselor |
101YP2500X | Yes | ||
| Counseling Psychologist |
103TC1900X | |||
| Clinical Social Worker |
1041C0700X | |||
| Psychiatric/Mental Health Registered Nurse |
163WP0808X | |||
| Psychiatry Physician |
2084P0800X | |||
| Art Therapist |
221700000X | |||
| Music Therapist |
225A00000X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | |||
| Psychiatric/Mental Health Clinical Nurse Specialist |
364SP0808X |
Addresses
Primary practice location
24073 Crescent St
Mattawan, MI 49071-8457
Mailing address
PO Box 714
Mattawan, MI 49071-0714
Other providers in Mattawan, MI
- Affinity Health Management LLC
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- Eden Sky Black
- Michael Robert Blostica
- Jennifer Lynn Bower
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All providers in Mattawan, MI · Professional Counselor in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.