Healthcare Provider Details

I. General information

NPI: 1073164349
Provider Name (Legal Business Name): PLYMOUTH MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40600 ANN ARBOR RD E STE 175
PLYMOUTH MI
48170-4664
US

IV. Provider business mailing address

40600 ANN ARBOR RD E STE 175
PLYMOUTH MI
48170-4664
US

V. Phone/Fax

Practice location:
  • Phone: 734-674-7579
  • Fax:
Mailing address:
  • Phone: 734-674-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALISHIA EBEL
Title or Position: OWNER
Credential: LMSW
Phone: 734-674-7579