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General NPI Number Information
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NPI Number | 1043348311
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Entity Type | Organization
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Legal Business Name | ST JOSEPH MERCY BEHAVIORAL SERVICES
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10299 GRAND RIVER RD
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City | BRIGHTON
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State | MI
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Zip | 48116-6541
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Country | US
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Telephone | 810-844-7311
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Fax |
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Provider Business Mailing Address
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Address Line | 3482 E DEAN RD
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City | HOWELL
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State | MI
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Zip | 48855-8234
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Country | US
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Telephone | 517-545-5752
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. PETER A. ROSEMAN
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Credential | PSY.S.
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Telephone | 810-844-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State | MI
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