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NPI Code Detail

MEDICARE: HENRY FORD BEHAVIORL HEALTH- TROY MEDICAL CENTER

MEDICARE: HENRY FORD BEHAVIORL HEALTH- TROY MEDICAL CENTER
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
1261QM0850XAdult Mental Health Clinic/Center
2261QM0855XAdolescent and Children Mental Health Clinic/Center
3261Q00000XClinic/Center

General Provider Information

NPI Number : 1568495208
Entity Type Code : Organization
Provider Name (Legal Business Name) : HENRY FORD BEHAVIORL HEALTH- TROY MEDICAL CENTER
Provider Business Mailing Address
First Line : 2825 LIVERNOIS RD
Second Line :
City : TROY
State : MI
Zip : 48083-1214
Country : US
Telephone Number : 248-680-2060
Fax Number : 248-608-2099
Provider Business Practice Location Address
First Line : 2825 LIVERNOIS RD
Second Line :
City : TROY
State : MI
Zip : 48083-1214
Country : US
Telephone Number : 248-680-2060
Fax Number : 248-608-2099
Authorized Official
Title or Position : SR. V. P
Name : MR. JAMES CONNELLY
Credential :
Telephone Number : 313-874-8714
Provider Enumeration Date : 07/08/2006
Last Update Date : 09/11/2025

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