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General NPI Number Information
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NPI Number | 1114317476
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Entity Type | Organization
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Legal Business Name | ADAMS BEHAVIORAL & PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 17340 W 12 MILE RD STE 205
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City | SOUTHFIELD
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State | MI
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Zip | 48076-6322
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Country | US
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Telephone | 313-402-7779
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Fax |
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Provider Business Mailing Address
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Address Line | 17340 W 12 MILE RD STE 205
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City | SOUTHFIELD
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State | MI
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Zip | 48076-6322
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Country | US
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Telephone | 313-402-7779
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | ALLEN RUSSELL ADAMS
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Credential |
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Telephone | 313-402-7779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 6801088547
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License Number State | MI
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