| NPI | 1780097063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEE LYNN BATES Administrator 313-731-7166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC0700X Psychologist, Clinical | |
| 103TC1900X Psychologist, Counseling | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 104100000X Social Worker | |
| 225XM0800X Occupational Therapist, Mental Health | |
| 251B00000X Case Management | |
| 251S00000X | |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult | |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2014-06-04 |