Healthcare Provider Details

I. General information

NPI: 1104147347
Provider Name (Legal Business Name): PSYCHIATRIC SUPPORT SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 N HAGGERTY RD SUITE 100
CANTON MI
48187-3605
US

IV. Provider business mailing address

20010 FARMINGTON RD
LIVONIA MI
48152-1408
US

V. Phone/Fax

Practice location:
  • Phone: 248-471-7171
  • Fax: 248-471-1212
Mailing address:
  • Phone: 248-471-7171
  • Fax: 248-471-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRYAN S. WEINSTEIN
Title or Position: OWNER
Credential: D.O.
Phone: 248-471-7171