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General NPI Number Information
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NPI Number | 1740758499
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Entity Type | Organization
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Legal Business Name | MICHIGAN MENTAL AND BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 11/09/2018
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 26743 S RIVER PARK DR
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City | INKSTER
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State | MI
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Zip | 48141-1851
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Country | US
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Telephone | 313-717-5911
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Fax |
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Provider Business Mailing Address
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Address Line | 7300 WILDERNESS PARK DR APT 204
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City | WESTLAND
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State | MI
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Zip | 48185-5978
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERT BRADLEY
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Credential |
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Telephone | 313-850-6821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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