MEDICARE: MICHIGAN BEHAVIORAL HEALTH INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	6301044754	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF044754	OTHER	MI	BCBS OF MICHIGAN
2	2607301861	OTHER	MI	HEALTH PLUS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659422483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN BEHAVIORAL HEALTH INSTITUTE

Provider Business Mailing Address
First Line	:	690 S TRUMBULL ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7656
Country	:	US
Telephone Number	:	989-922-4900
Fax Number	:	989-922-4911

Provider Business Practice Location Address
First Line	:	690 S TRUMBULL ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7656
Country	:	US
Telephone Number	:	989-922-4900
Fax Number	:	989-922-4911

Authorized Official
Title or Position	:	ADDICTIONIST
Name	:	DOUGLAS LEROY FOSTER
Credential	:	M.D.
Telephone Number	:	989-922-4900

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/22/2020

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