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General NPI Number Information
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NPI Number | 1255087698
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Entity Type | Organization
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Legal Business Name | ADVANCED MENTAL HEALTH AND TBI SERVICES PLLC
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 9864 E GRAND RIVER AVE STE 110-131
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City | BRIGHTON
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State | MI
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Zip | 48116-1963
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Country | US
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Telephone | 810-844-6146
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Fax | 248-282-7022
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Provider Business Mailing Address
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Address Line | 1384 SEWARD CT
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City | BRIGHTON
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State | MI
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Zip | 48116-3790
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Country | US
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Telephone | 810-844-6146
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Fax | 248-282-7022
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Authorized Official
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Title or Position | OWNER
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Name | DONALD BOOTH
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Credential | LMSW
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Telephone | 810-844-6146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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