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General NPI Number Information
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NPI Number | 1740450279
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Entity Type | Organization
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Legal Business Name | HERON RIDGE ASSOCIATES, PLC
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 1785 W STADIUM BLVD STE 205
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City | ANN ARBOR
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State | MI
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Zip | 48103-5285
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Country | US
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Telephone | 734-454-3560
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Fax | 248-391-7478
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Provider Business Mailing Address
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Address Line | 3694 CLARKSTON RD SUITE D
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City | CLARKSTON
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State | MI
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Zip | 48348-5213
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Country | US
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Telephone | 248-693-8880
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Fax | 248-391-7478
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Authorized Official
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Title or Position | PRESIDENT, SECRETARY, TREASURER
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Name | ELLIOTT RICHELSON
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Credential | M.D.
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Telephone | 904-605-4986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 631112
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License Number State | MI
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