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General NPI Number Information
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NPI Number | 1104785682
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Entity Type | Organization
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Legal Business Name | MICHIGAN MINDS, LLC
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Dates
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Enumeration Date | 01/20/2026
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 5555 CONNER ST
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City | DETROIT
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State | MI
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Zip | 48213-3448
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Country | US
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Telephone | 313-209-1041
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Fax |
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Provider Business Mailing Address
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Address Line | 20427 TRACEY ST
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City | DETROIT
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State | MI
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Zip | 48235-1572
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Country | US
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Telephone | 313-687-3729
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MARKEAH AMES
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Credential |
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Telephone | 313-687-3729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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