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General NPI Number Information
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NPI Number | 1356554059
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Entity Type | Organization
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Legal Business Name | ORCHARDS CHILDREN'S SERVICES, INC.
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 24901 NORTHWESTERN HWY STE 500
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2212
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Country | US
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Telephone | 248-258-0440
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Fax | 248-258-0458
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Provider Business Mailing Address
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Address Line | 24901 NORTHWESTERN HWY STE 500
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2212
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Country | US
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Telephone | 248-258-0044
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Fax | 248-258-0458
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Authorized Official
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Title or Position | CLINICAL PROGRAM MANAGER
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Name | JEFFERY JOSEPH LUSKO
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Credential | MA, LLP
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Telephone | 248-258-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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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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