Healthcare Provider Details

I. General information

NPI: 1043348311
Provider Name (Legal Business Name): ST JOSEPH MERCY BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10299 GRAND RIVER RD
BRIGHTON MI
48116-6541
US

IV. Provider business mailing address

3482 E DEAN RD
HOWELL MI
48855-8234
US

V. Phone/Fax

Practice location:
  • Phone: 810-844-7311
  • Fax:
Mailing address:
  • Phone: 517-545-5752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. PETER A. ROSEMAN
Title or Position: THERAPIST
Credential: PSY.S.
Phone: 810-844-7300