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General NPI Number Information
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NPI Number | 1700141215
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Entity Type | Organization
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Legal Business Name | FIRST BEHAVIORAL CHOICE LLC
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 8537 VAN DYKE ST
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City | DETROIT
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State | MI
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Zip | 48213-2374
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Country | US
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Telephone | 734-377-9282
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Fax |
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Provider Business Mailing Address
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Address Line | 643 HORTON ST
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City | DETROIT
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State | MI
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Zip | 48202-3138
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Country | US
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Telephone | 734-377-9282
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LYNNETTE ROBERSON
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Credential |
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Telephone | 734-377-9282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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