Healthcare Provider Details

I. General information

NPI: 1700324548
Provider Name (Legal Business Name): BIOMED BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 SUMMIT DR
WATERFORD MI
48328-3364
US

IV. Provider business mailing address

727 W GRAND BLVD APT. 150
DETROIT MI
48216-2119
US

V. Phone/Fax

Practice location:
  • Phone: 248-706-5041
  • Fax:
Mailing address:
  • Phone: 248-417-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY FELICIA HARTSFIELD
Title or Position: COUNSELOR
Credential:
Phone: 248-417-0929