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General NPI Number Information
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NPI Number | 1851796734
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Entity Type | Organization
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Legal Business Name | TEAM MENTAL HEALTH SERVICES, INC
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 2925 RUSSELL ST
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City | DETROIT
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State | MI
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Zip | 48207-4825
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Country | US
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Telephone | 313-396-5300
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Fax | 313-274-4900
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Provider Business Mailing Address
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Address Line | 290 TOWN CENTER DR
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City | DEARBORN
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State | MI
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Zip | 48126-2739
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Country | US
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Telephone | 313-274-3700
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Fax | 313-274-4900
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Authorized Official
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Title or Position | CEO
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Name | ANTONIO POLLICELLA
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Credential |
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Telephone | 313-274-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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