Healthcare Provider Details

I. General information

NPI: 1467221762
Provider Name (Legal Business Name): CONNECTERE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8441 MARYGROVE DR
DETROIT MI
48221-2942
US

IV. Provider business mailing address

PO BOX 211172
DETROIT MI
48221-5172
US

V. Phone/Fax

Practice location:
  • Phone: 586-300-4477
  • Fax:
Mailing address:
  • Phone: 586-300-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATRINA HARRIS
Title or Position: OWNER
Credential: LMSW-CLINICAL
Phone: 586-300-4477