Provisional Therapy Associates

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

PROVISIONAL THERAPY ASSOCIATES

Practice address

4241 Breckenridge Dr
West Bloomfield, MI 48322-4430

Phone

(248) 240-2963

NPI assigned

Apr 15, 2024

Last updated

Apr 15, 2024By 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

Lina Mari Escamilla, LMSWNPI 1639302458

Title

Group Representative

Phone

(248) 240-2963

Specialties & licenses 1

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.

• Lina Escamilla, LMSW

  • Social Worker
  • Flint, MI
  • NPI 1639302458
  NPD Authorized official

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1831943026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4241 BRECKENRIDGE DR",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483224430",
            "telephone_number": "248-240-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4241 BRECKENRIDGE DR",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483224430",
            "telephone_number": "248-240-2963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISIONAL THERAPY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-14",
        "status": "A",
        "authorized_official_last_name": "ESCAMILLA",
        "authorized_official_first_name": "LINA",
        "authorized_official_middle_name": "MARI",
        "authorized_official_title_or_position": "GROUP REPRESENTATIVE",
        "authorized_official_telephone_number": "248-240-2963",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in West Bloomfield, MI
• Providers in West Bloomfield, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.