Healthcare Provider Details

I. General information

NPI: 1659422483
Provider Name (Legal Business Name): MICHIGAN BEHAVIORAL HEALTH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 S TRUMBULL ST
BAY CITY MI
48708-7656
US

IV. Provider business mailing address

690 S TRUMBULL ST
BAY CITY MI
48708-7656
US

V. Phone/Fax

Practice location:
  • Phone: 989-922-4900
  • Fax: 989-922-4911
Mailing address:
  • Phone: 989-922-4900
  • Fax: 989-922-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6301044754
License Number StateMI

VIII. Authorized Official

Name: DOUGLAS LEROY FOSTER
Title or Position: ADDICTIONIST
Credential: M.D.
Phone: 989-922-4900