Healthcare Provider Details

I. General information

NPI: 1104785682
Provider Name (Legal Business Name): MICHIGAN MINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14061 E 13 MILE RD STE 5
WARREN MI
48088-5866
US

IV. Provider business mailing address

20427 TRACEY ST
DETROIT MI
48235-1572
US

V. Phone/Fax

Practice location:
  • Phone: 313-209-1041
  • Fax:
Mailing address:
  • Phone: 313-209-1041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARKEAH AMES
Title or Position: CLINIC MANAGER
Credential:
Phone: 313-687-3729