=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669179545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUR TIME BEHAVIORAL & MENTAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2023
-----------------------------------------------------
Last Update Date | 10/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8702 WANDERING WAY
-----------------------------------------------------
City | FREELAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48623-9557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-999-8463
-----------------------------------------------------
Fax | 989-266-1440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 210
-----------------------------------------------------
City | FREELAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48623-0210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-999-8463
-----------------------------------------------------
Fax | 989-266-1440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | PATRICK R DUDLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-999-8463
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------