Organization
J&P COUSINS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AUDRERY ELAINE SMITH MPH (CHIEF EXECUTIVE OFFICER)
(313) 402-9608
Entity
Organization
Contact information
Practice address
21040 GREENFIELD RD, OAK PARK, MI 48237-3025
(313) 402-9608
Mailing address
18082 PARKSIDE ST, DETROIT, MI 48221-2719
(313) 402-9608
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TC1900X
Counseling Psychologist
—
—
104100000X
Social Worker
—
—
171400000X
Health & Wellness Coach
—
—
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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