Healthcare Provider Details

I. General information

NPI: 1881916310
Provider Name (Legal Business Name): OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 EXECUTIVE HILLS DR
AUBURN HILLS MI
48326-2944
US

IV. Provider business mailing address

2011 EXECUTIVE HILLS DR
AUBURN HILLS MI
48326-2944
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-1210
  • Fax:
Mailing address:
  • Phone: 248-858-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. THERESA MAUREEN ANCICK
Title or Position: SENIOR APPLICATION ANALYST
Credential:
Phone: 248-858-4906