Healthcare Provider Details

I. General information

NPI: 1669451944
Provider Name (Legal Business Name): LINCOLN BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9315 TELEGRAPH RD
REDFORD MI
48239
US

IV. Provider business mailing address

9315 TELEGRAPH RD
REDFORD MI
48239-1260
US

V. Phone/Fax

Practice location:
  • Phone: 313-450-4500
  • Fax: 313-450-4514
Mailing address:
  • Phone: 313-450-4500
  • Fax: 313-450-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: THERESA KORROCH
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, LLP
Phone: 313-450-4500