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General NPI Number Information
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NPI Number | 1427390178
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Entity Type | Organization
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Legal Business Name | FENTON BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 03/20/2013
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Provider Practice Location Address
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Address Line | 1122 N LEROY ST STE C
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City | FENTON
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State | MI
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Zip | 48430-2789
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Country | US
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Telephone | 810-629-4224
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Fax | 810-629-4234
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Provider Business Mailing Address
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Address Line | 1122 N LEROY ST STE C
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City | FENTON
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State | MI
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Zip | 48430-2789
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Country | US
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Telephone | 810-629-4224
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Fax | 810-629-4234
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Authorized Official
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Title or Position | OWNER/OPERATOR/PRACTITIONER
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Name | MR. DUANE EDWARD LAGUIRE-QUINN
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Credential | LMSW, ACSW
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Telephone | 810-629-4224
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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 | 250045
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License Number State | MI
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