Healthcare Provider Details

I. General information

NPI: 1477066140
Provider Name (Legal Business Name): NEXUS BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 ROCHESTER RD # 205
TROY MI
48083-5426
US

IV. Provider business mailing address

3334 ROCHESTER RD # 205
TROY MI
48083-5426
US

V. Phone/Fax

Practice location:
  • Phone: 843-450-8611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW KADRICH
Title or Position: PRESIDENT
Credential: PSY.D., LP
Phone: 843-450-8611