Healthcare Provider Details

I. General information

NPI: 1619315538
Provider Name (Legal Business Name): APEX BEHAVIORAL HEALTH WESTERN-WAYNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 S WAYNE RD
WESTLAND MI
48186-5436
US

IV. Provider business mailing address

1547 S WAYNE RD
WESTLAND MI
48186-5436
US

V. Phone/Fax

Practice location:
  • Phone: 734-729-3133
  • Fax:
Mailing address:
  • Phone: 734-729-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: TAE W PARK
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 734-729-3133