Provider Demographics
NPI:1235999368
Name:FM THERAPY
Entity type:Organization
Organization Name:FM THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLICK
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:734-945-2507
Mailing Address - Street 1:1905 S HAGGERTY RD # 40
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2025
Mailing Address - Country:US
Mailing Address - Phone:734-945-2507
Mailing Address - Fax:
Practice Address - Street 1:1905 S HAGGERTY RD # 40
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2025
Practice Address - Country:US
Practice Address - Phone:734-945-2507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty