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Contact Information

BLAQ THERAPY
24073 CRESCENT ST
MATTAWAN, MI49071-8457
 Phone: 734-802-7667
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Professional

101YP2500X
 

Art Therapist

221700000X
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Counseling

103TC1900X 62 Psychologist, Clinical
 

Mental Health

101YM0800X
 

Music Therapist

225A00000X
 

Psychiatric/Mental Health

363LP0808X 50 Nurse Practitioner
 

Psychiatric/Mental Health

364SP0808X 89 Certified Clinical Nurse Specialist
 

Psychiatric/Mental Health

163WP0808X
 

Psychiatry

2084P0800X 26 Physician/Psychiatry
Indicates primary specialty

NPI Profile & details for BLAQ THERAPY · (Female)

NPI # 1609646256
Status Active
Credentials
Entity Individual
Enumeration date 01/04/2024
Last updated 01/04/2024 - About 2 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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