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General NPI Number Information
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NPI Number | 1861610750
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Entity Type | Organization
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Legal Business Name | MILL STREET PSYCHIATRIC & MEDICAL CLINIC P L C
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 380 MILL ST
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City | ORTONVILLE
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State | MI
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Zip | 48462-8721
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Country | US
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Telephone | 248-961-3088
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Fax | 248-627-7682
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Provider Business Mailing Address
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Address Line | 927 EVERGREEN RIDGE
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City | ORTONVILLE
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State | MI
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Zip | 48462-8721
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Country | US
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Telephone | 248-961-3088
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | JANET DELORES HEASLEY
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Credential | D.O.
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Telephone | 248-627-7682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | JH013119
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License Number State | MI
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