Healthcare Provider Details

I. General information

NPI: 1083823835
Provider Name (Legal Business Name): MID-MICHIGAN BEHAVIORAL HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W KING ST STE G
OWOSSO MI
48867-2100
US

IV. Provider business mailing address

802 W KING ST STE G
OWOSSO MI
48867-2100
US

V. Phone/Fax

Practice location:
  • Phone: 989-725-8124
  • Fax: 989-723-1205
Mailing address:
  • Phone: 989-725-8124
  • Fax: 989-723-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NAZAR A AL-SAIDI
Title or Position: PRESIDENT
Credential: MD
Phone: 989-725-8124