Healthcare Provider Details

I. General information

NPI: 1497272496
Provider Name (Legal Business Name): MONARCH BEHAVIORAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35980 WOODWARD AVE STE 100
BLOOMFIELD HILLS MI
48304-0903
US

IV. Provider business mailing address

35980 WOODWARD AVE STE 100
BLOOMFIELD HILLS MI
48304-0903
US

V. Phone/Fax

Practice location:
  • Phone: 248-220-3332
  • Fax:
Mailing address:
  • Phone: 248-220-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301016726
License Number StateMI

VIII. Authorized Official

Name: JULIE BRACISZEWSKI
Title or Position: SOLE MEMBER
Credential: PHD
Phone: 248-220-3332