1346079936 NPI number — ROYALTY BEHAVIORAL AND COUNSELING SERVICES

Table of content: DR. STEPHEN GRANT VANOOTEGHEM M.D. (NPI 1710246087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346079936 NPI number — ROYALTY BEHAVIORAL AND COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROYALTY BEHAVIORAL AND COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346079936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26614 W CHICAGO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48239-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-658-9580
Provider Business Mailing Address Fax Number:
313-612-9090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26614 W CHICAGO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48239-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-658-9580
Provider Business Practice Location Address Fax Number:
313-612-9090
Provider Enumeration Date:
07/31/2024

Additional Information

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
KENDELLA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-658-9580

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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