Healthcare Provider Details

I. General information

NPI: 1831190701
Provider Name (Legal Business Name): MACOMB FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36975 UTICA RD SUITE 103
CLINTON TOWNSHIP MI
48036-1685
US

IV. Provider business mailing address

36975 UTICA RD SUITE 103
CLINTON TOWNSHIP MI
48036-1685
US

V. Phone/Fax

Practice location:
  • Phone: 586-226-3440
  • Fax: 586-226-3740
Mailing address:
  • Phone: 586-226-3440
  • Fax: 586-226-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberN/A
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberN/A
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: OWEN PFAENDTNER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 586-336-0422