Healthcare Provider Details

I. General information

NPI: 1407648959
Provider Name (Legal Business Name): MATTIOLI MENTAL HEALTH CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10524 GRAND RIVER RD STE 101
BRIGHTON MI
48116-9559
US

IV. Provider business mailing address

10524 GRAND RIVER RD STE 101
BRIGHTON MI
48116-9559
US

V. Phone/Fax

Practice location:
  • Phone: 810-498-9455
  • Fax:
Mailing address:
  • Phone: 810-498-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY RALPH MATTIOLI
Title or Position: OWNER
Credential: DO
Phone: 810-498-9455