Healthcare Provider Details

I. General information

NPI: 1760807671
Provider Name (Legal Business Name): BEHAVIORAL HEALTH OF ROCHESTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 CHESTNUT CIR
ROCHESTER HLS MI
48309-1714
US

IV. Provider business mailing address

1344 CHESTNUT CIR
ROCHESTER HLS MI
48309-1714
US

V. Phone/Fax

Practice location:
  • Phone: 248-891-0991
  • Fax:
Mailing address:
  • Phone: 248-891-0991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6801093319
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6801093319
License Number StateMI

VIII. Authorized Official

Name: MS. KAREN R FARRAR
Title or Position: OWNER; SOCIAL WORKER
Credential: LMSW
Phone: 248-891-0991