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General NPI Number Information
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NPI Number | 1467221762
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Entity Type | Organization
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Legal Business Name | CONNECTERE LLC
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Dates
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Enumeration Date | 12/28/2023
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 8441 MARYGROVE DR
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City | DETROIT
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State | MI
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Zip | 48221-2942
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Country | US
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Telephone | 586-300-4477
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 211172
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City | DETROIT
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State | MI
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Zip | 48221-5172
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Country | US
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Telephone | 586-300-4477
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATRINA HARRIS
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Credential | LMSW-CLINICAL
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Telephone | 586-300-4477
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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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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 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 |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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