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General NPI Number Information
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NPI Number | 1568903268
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Entity Type | Organization
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Legal Business Name | CENTER OF BEHAVIORAL THERAPY, INC.
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 28807 8 MILE RD SUITE 102
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City | LIVONIA
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State | MI
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Zip | 48152-2078
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Country | US
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Telephone | 248-471-5550
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Fax | 248-471-5556
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Provider Business Mailing Address
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Address Line | 28807 8 MILE RD SUITE 102
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City | LIVONIA
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State | MI
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Zip | 48152-2078
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Country | US
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Telephone | 248-471-5550
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Fax | 248-471-5556
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Authorized Official
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Title or Position | BOARD OF DIRECTOR
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Name | MRS. SHAWNTAY LANESHA DIXON
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Credential | M.B.A.
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Telephone | 248-471-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 820734
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License Number State | MI
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