Provider Demographics
NPI:1215626122
Name:MIND OF MY MAKING INTEGRATIVE PSYCHOTHERAPY PLLC
Entity type:Organization
Organization Name:MIND OF MY MAKING INTEGRATIVE PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAMONT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-529-0703
Mailing Address - Street 1:10426 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7578
Mailing Address - Country:US
Mailing Address - Phone:313-529-0703
Mailing Address - Fax:
Practice Address - Street 1:10426 OVERHILL DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7578
Practice Address - Country:US
Practice Address - Phone:313-529-0703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty