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General NPI Number Information
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NPI Number | 1467883744
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Entity Type | Organization
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Legal Business Name | ADVANCED MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 2866 E COUNTRY LN
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City | MONROE
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State | MI
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Zip | 48162-8938
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Country | US
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Telephone | 734-819-8048
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Fax | 734-240-1892
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Provider Business Mailing Address
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Address Line | 2866 E COUNTRY LN
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City | MONROE
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State | MI
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Zip | 48162-8938
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Country | US
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Telephone | 734-819-8048
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Fax | 734-240-1892
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Authorized Official
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Title or Position | OWNER
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Name | AMAL BUTLER
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Credential | LMSW
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Telephone | 734-819-8048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801066663
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License Number State | MI
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