Healthcare Provider Details

I. General information

NPI: 1700915071
Provider Name (Legal Business Name): DOWNRIVER MENTAL HEALTH CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5958 N CANTON CENTER RD SUITE 900
CANTON MI
48187-2765
US

IV. Provider business mailing address

20600 EUREKA RD SUITE 819
TAYLOR MI
48180-5343
US

V. Phone/Fax

Practice location:
  • Phone: 734-737-1200
  • Fax: 734-737-1205
Mailing address:
  • Phone: 734-285-8282
  • Fax: 734-281-0402

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

VIII. Authorized Official

Name: PATRICIA F BEACH
Title or Position: PROVIDER RELATIONS
Credential: LMSW ACSW BCD
Phone: 248-213-0501