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General NPI Number Information
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NPI Number | 1679393797
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Entity Type | Organization
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Legal Business Name | HURON RIVER PSYCHIATRY PC
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 3200 W LIBERTY RD STE F
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City | ANN ARBOR
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State | MI
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Zip | 48103-9180
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Country | US
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Telephone | 734-780-7080
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Fax | 734-545-8663
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Provider Business Mailing Address
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Address Line | 3200 W LIBERTY RD STE F1
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City | ANN ARBOR
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State | MI
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Zip | 48103-9746
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Country | US
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Telephone | 734-780-7080
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Fax | 734-545-8663
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | RACHELLE WILLIAMS
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Credential |
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Telephone | 734-245-7822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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