Healthcare Provider Details

I. General information

NPI: 1336527571
Provider Name (Legal Business Name): FIRSTPLAN HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 S MAIN ST STE 103C
MOUNT CLEMENS MI
48043-7900
US

IV. Provider business mailing address

148 S MAIN ST STE 103C
MOUNT CLEMENS MI
48043-7900
US

V. Phone/Fax

Practice location:
  • Phone: 248-579-9791
  • Fax: 586-229-2874
Mailing address:
  • Phone: 248-579-9791
  • Fax: 586-229-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801087640
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801087640
License Number StateMI

VIII. Authorized Official

Name: JOSEPH EMANUEL HINES
Title or Position: MEMBER
Credential: LMSW
Phone: 248-579-9791