Provider Demographics
NPI:1063090686
Name:TRAUMA TREATMENT COLLECTIVE PLLC
Entity type:Organization
Organization Name:TRAUMA TREATMENT COLLECTIVE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:757-537-1929
Mailing Address - Street 1:RA - 37 ALELI STREET
Mailing Address - Street 2:ROSALEDA DEVELOPMENT II
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:757-537-1929
Mailing Address - Fax:
Practice Address - Street 1:20411 W 12 MILE RD # SUIE104
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5414
Practice Address - Country:US
Practice Address - Phone:757-537-1929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty