Healthcare Provider Details

I. General information

NPI: 1790072817
Provider Name (Legal Business Name): WASHTENAW COUNTY COMMUNITY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2011
Last Update Date: 07/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SHERIDAN ST
YPSILANTI MI
48197-2712
US

IV. Provider business mailing address

909 SHERIDAN ST
YPSILANTI MI
48197-2712
US

V. Phone/Fax

Practice location:
  • Phone: 734-646-8426
  • Fax:
Mailing address:
  • Phone: 734-646-8426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JASON ANDREW SEILER
Title or Position: CLINCIAL DIRECTOR
Credential: MA LPC NCC CAADC
Phone: 734-646-8426