Provider Demographics
NPI:1427709252
Name:GOOD HEALTH AND AGING WELL ON PURPOSE COUNSELING AND COACHING CENTER P
Entity type:Organization
Organization Name:GOOD HEALTH AND AGING WELL ON PURPOSE COUNSELING AND COACHING CENTER P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:LLPC
Authorized Official - Phone:248-667-1247
Mailing Address - Street 1:PO BOX 2355
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48123-2355
Mailing Address - Country:US
Mailing Address - Phone:248-667-1247
Mailing Address - Fax:313-406-6796
Practice Address - Street 1:17344 W 12 MILE RD STE 204
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6321
Practice Address - Country:US
Practice Address - Phone:248-667-1247
Practice Address - Fax:313-406-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty