Healthcare Provider Details

I. General information

NPI: 1376700559
Provider Name (Legal Business Name): APEX BEHAVIORAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD STE 311
DEARBORN MI
48124-5031
US

IV. Provider business mailing address

18317 FARMINGTON RD
LIVONIA MI
48152-3253
US

V. Phone/Fax

Practice location:
  • Phone: 313-271-8170
  • Fax: 313-271-8353
Mailing address:
  • Phone: 248-427-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number63001008325
License Number StateMI

VIII. Authorized Official

Name: DR. TANYA LYNNETTE MARTIN
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYDLLP
Phone: 313-271-8170