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General NPI Number Information
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NPI Number | 1841651270
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Entity Type | Organization
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Legal Business Name | PROACTIVE MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 03/12/2016
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Last Update Date | 07/24/2016
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Provider Practice Location Address
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Address Line | 45184 CASS AVE
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City | UTICA
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State | MI
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Zip | 48317-5507
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Country | US
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Telephone | 586-930-5590
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Fax |
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Provider Business Mailing Address
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Address Line | 45184 CASS AVE
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City | UTICA
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State | MI
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Zip | 48317-5507
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Country | US
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Telephone | 586-930-5590
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. LISA DEMOPOULOS
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Credential | PSY.D., LLP, LMSW
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Telephone | 586-219-4782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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