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General NPI Number Information
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NPI Number | 1407188386
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Entity Type | Organization
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Legal Business Name | INTERVENTIVE BEHAVIORAL COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 35551 FORD RD SUITE 101
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City | WESTLAND
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State | MI
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Zip | 48185-3113
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Country | US
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Telephone | 313-720-6702
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Fax | 313-846-1975
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Provider Business Mailing Address
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Address Line | 35551 FORD RD SUITE 101
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City | WESTLAND
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State | MI
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Zip | 48185-3113
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Country | US
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Telephone | 313-720-6702
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Fax | 313-846-1975
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MICHAEL LOVELL TUCKER
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Credential | MSW, MA
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Telephone | 313-720-6702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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