Provider Demographics
NPI:1427865443
Name:WALNUT THERAPY CENTER PLLC
Entity type:Organization
Organization Name:WALNUT THERAPY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DORAN
Authorized Official - Suffix:
Authorized Official - Credentials:LLP, LMFT, LLPC
Authorized Official - Phone:248-505-6289
Mailing Address - Street 1:71 WALNUT BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2073
Mailing Address - Country:US
Mailing Address - Phone:248-505-6289
Mailing Address - Fax:
Practice Address - Street 1:71 WALNUT BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2073
Practice Address - Country:US
Practice Address - Phone:248-505-6289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty