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General NPI Number Information
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NPI Number | 1649581794
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Entity Type | Organization
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Legal Business Name | MICHIGAN PSYCHIATRIC & BEHAVIORAL ASSOC
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 690 S TRUMBULL ST
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City | BAY CITY
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State | MI
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Zip | 48708-7692
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Country | US
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Telephone | 989-922-4900
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Fax | 989-922-4911
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Provider Business Mailing Address
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Address Line | 690 S TRUMBULL ST
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City | BAY CITY
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State | MI
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Zip | 48708-7692
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Country | US
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Telephone | 989-922-4900
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Fax | 989-922-4911
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MISS LISA M WILLIAMS
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Credential | BA, LBSW
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Telephone | 989-922-4900
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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 | ON34080
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License Number State | MI
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