Healthcare Provider Details

I. General information

NPI: 1841781531
Provider Name (Legal Business Name): BLUESTONE CHILDRENS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 08/30/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38935 ANN ARBOR RD
LIVONIA MI
48150-3397
US

IV. Provider business mailing address

38935 ANN ARBOR RD STE 150
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 248-886-9540
  • Fax: 248-254-6613
Mailing address:
  • Phone: 248-886-9540
  • Fax: 248-254-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JAN GREULICH
Title or Position: AUTHORIZED OFFICIAL/ MANAGER
Credential:
Phone: 313-900-8009