MEDICARE: MATRIX HUMAN SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	2084P0800X	Psychiatry Physician	4301088119	MI

General Provider Information

NPI Number	:	1073924585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRIX HUMAN SERVICES

Provider Business Mailing Address
First Line	:	120 PARSONS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2002
Country	:	US
Telephone Number	:	313-831-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 PARSONS ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2002
Country	:	US
Telephone Number	:	313-831-1000
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. MARCELLA WILSON
Credential	:	PH.D.
Telephone Number	:	313-831-1000

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	04/29/2015

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Directions to “MATRIX HUMAN SERVICES ” Practice Location

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