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General NPI Number Information
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NPI Number | 1649405689
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Entity Type | Organization
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Legal Business Name | OPEN MIND THERAPY PLC
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 2002 HOGBACK RD STE 15
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City | ANN ARBOR
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State | MI
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Zip | 48105-9736
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Country | US
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Telephone | 734-646-8765
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Fax |
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Provider Business Mailing Address
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Address Line | 266O CHATEAU COURT
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City | ANN ARBOR
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State | MI
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Zip | 48103
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Country | US
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Telephone | 734-646-8765
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SULAN MARIE GREEN
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Credential | LMSW
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Telephone | 734-646-8765
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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 | 681087295
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License Number State | MI
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