MEDICARE: UMBRELLEX BEHAVIORAL HEALTH 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1144723404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UMBRELLEX BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	13854 LAKESIDE CIR STE 255
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-1443
Country	:	US
Telephone Number	:	248-206-5787
Fax Number	:

Provider Business Practice Location Address
First Line	:	13854 LAKESIDE CIR STE 255
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-1443
Country	:	US
Telephone Number	:	248-206-5787
Fax Number	:

Authorized Official
Title or Position	:	CO OWNER
Name	:	BIANCA WILSON
Credential	:	LMSW, SSW
Telephone Number	:	248-206-5787

Provider Enumeration Date	:	03/13/2018
Last Update Date	:	12/14/2023

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