Healthcare Provider Details

I. General information

NPI: 1760289995
Provider Name (Legal Business Name): MICHIGAN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 05/02/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8062 CHALLIS RD #1007
BRIGHTON MI
48116-7446
US

IV. Provider business mailing address

8063 CHALLIS RD # 1007
BRIGHTON MI
48116-7446
US

V. Phone/Fax

Practice location:
  • Phone: 810-844-1765
  • Fax:
Mailing address:
  • Phone: 810-844-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
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: NANCY BURTON
Title or Position: LLC
Credential:
Phone: 810-844-1765