| NPI | 1871984880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY CASEY CODEN Behavioral Therapist 313-330-9732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI c350108229) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2015-02-12 |