=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679870737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAKLAND COUNTY COMMUNITY MENTAL HEALTH AUTHORITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2011
-----------------------------------------------------
Last Update Date | 02/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2011 EXECUTIVE HILLS BLVD
-----------------------------------------------------
City | AUBURN HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-858-1210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2011 EXECUTIVE HILLS BLVD
-----------------------------------------------------
City | AUBURN HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-858-1210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FISCAL ANALYST
-----------------------------------------------------
Name | MRS. KELLI DIEM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-452-9862
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | N/A
-----------------------------------------------------
License Number State |
-----------------------------------------------------