Healthcare Provider Details

I. General information

NPI: 1730897711
Provider Name (Legal Business Name): KINDMIND BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 S MAIN ST STE 101
CLARKSTON MI
48346-2377
US

IV. Provider business mailing address

3000 INTERLAKEN ST
WEST BLOOMFIELD MI
48323-1820
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-2970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL NADHIR
Title or Position: OWNER
Credential:
Phone: 248-625-2970