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General NPI Number Information
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NPI Number | 1407889116
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Entity Type | Organization
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Legal Business Name | HENRY FORD BEHAVIORAL HEALTH- WEST BLOOMFIELD
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 6777 W MAPLE RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3013
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Country | US
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Telephone | 248-661-7393
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Fax | 248-661-7924
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Provider Business Mailing Address
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Address Line | 6777 W MAPLE RD
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3013
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Country | US
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Telephone | 248-661-7393
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Fax | 248-661-7924
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Authorized Official
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Title or Position | EVP, CHIEF FINANCE
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Name | ROBIN DAMSCHRODER
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Credential |
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Telephone | 248-648-7204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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