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General NPI Number Information
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NPI Number | 1023827003
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Entity Type | Organization
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Legal Business Name | OCTAVE BEHAVIORAL MICHIGAN PC
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 508 MEETING ST
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-7535
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Country | US
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Telephone | 415-360-3833
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Fax | 628-234-3048
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Provider Business Mailing Address
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Address Line | PO BOX 18481
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City | PALATINE
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State | IL
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Zip | 60055-8481
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Country | US
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Telephone | 415-360-3833
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Fax | 628-234-3048
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Authorized Official
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Title or Position | VP REVENUE OPERATIONS
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Name | KYM EVERETT
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Credential |
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Telephone | 650-504-2289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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