1801827746 NPI number — PSYCHIATRY AND BEHAVIORIAL MEDICINE PROFESSIONIALS

Table of content: (NPI 1801827746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801827746 NPI number — PSYCHIATRY AND BEHAVIORIAL MEDICINE PROFESSIONIALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHIATRY AND BEHAVIORIAL MEDICINE PROFESSIONIALS
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:
UNIVERSITY PSYCHIATRY CENTERS
Provider Other Organization Name Type Code:
3
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:
1801827746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 WOODWARD AVE
Provider Second Line Business Mailing Address:
SUITE 702
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201-2061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-262-1257
Provider Business Mailing Address Fax Number:
313-262-1238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2751 E JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48207-4180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-362-7792
Provider Business Practice Location Address Fax Number:
313-993-3421
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TANCER
Authorized Official First Name:
MANUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
313-577-0215

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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