Healthcare Provider Details

I. General information

NPI: 1306383252
Provider Name (Legal Business Name): TEAM MENTAL HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3646 MOUNT ELLIOTT ST
DETROIT MI
48207-2311
US

IV. Provider business mailing address

290 TOWN CENTER DR
DEARBORN MI
48126-2739
US

V. Phone/Fax

Practice location:
  • Phone: 313-626-2400
  • Fax: 313-921-4125
Mailing address:
  • Phone: 313-274-3700
  • Fax: 313-274-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO POLLICELLA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 313-274-3700