Provider Demographics
NPI:1053920561
Name:ENVISION THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:ENVISION THERAPY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOHNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-721-1244
Mailing Address - Street 1:1745 HAMILTON RD STE 355
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1954
Mailing Address - Country:US
Mailing Address - Phone:517-721-1244
Mailing Address - Fax:833-318-1465
Practice Address - Street 1:1745 HAMILTON RD STE 355
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1954
Practice Address - Country:US
Practice Address - Phone:517-721-1244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)