Healthcare Provider Details

I. General information

NPI: 1861081564
Provider Name (Legal Business Name): MENTAL HEALTH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7403 GRANDMONT AVE
DETROIT MI
48228-3624
US

IV. Provider business mailing address

7403 GRANDMONT AVE
DETROIT MI
48228-3624
US

V. Phone/Fax

Practice location:
  • Phone: 313-438-6253
  • Fax: 734-629-0631
Mailing address:
  • Phone: 313-438-6253
  • Fax: 734-629-0631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PATRICK WILLIAMS
Title or Position: OWNER/REGISTERED NURSE
Credential: RN
Phone: 313-778-5354