Provider Demographics
NPI:1215568340
Name:COMPLETE KETAMINE INC
Entity type:Organization
Organization Name:COMPLETE KETAMINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WERTENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:734-931-6004
Mailing Address - Street 1:98 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1957
Mailing Address - Country:US
Mailing Address - Phone:734-731-9500
Mailing Address - Fax:
Practice Address - Street 1:98 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1957
Practice Address - Country:US
Practice Address - Phone:734-731-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty