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General NPI Number Information
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NPI Number | 1306383252
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Entity Type | Organization
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Legal Business Name | TEAM MENTAL HEALTH SERVICES INC.
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 3646 MOUNT ELLIOTT ST
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City | DETROIT
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State | MI
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Zip | 48207-2311
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Country | US
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Telephone | 313-626-2400
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Fax | 313-921-4125
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Provider Business Mailing Address
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Address Line | 290 TOWN CENTER DR
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City | DEARBORN
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State | MI
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Zip | 48126-2739
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Country | US
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Telephone | 313-274-3700
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Fax | 313-274-4900
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ANTONIO POLLICELLA
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Credential |
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Telephone | 313-274-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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