Individual
BETTY JANE THACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
1787 W BIG BEAVER RD, SUITE 170, TROY, MI 48084-3548
(248) 971-0383
Mailing address
1719 WOODGATE DR, TROY, MI 48083-5526
(248) 528-9395
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401009796
MI
Other
Enumeration date
07/10/2012
Last updated
07/11/2012
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