1518361567 NPI number — PAUL D WINKLER BEHAVIORAL HEALTH SERVICES PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518361567 NPI number — PAUL D WINKLER BEHAVIORAL HEALTH SERVICES PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL D WINKLER BEHAVIORAL HEALTH SERVICES PLC
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:
6
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:
1518361567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2240 S AIRPORT RD W
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49684-4714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-642-4642
Provider Business Mailing Address Fax Number:
231-642-4640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2240 S AIRPORT RD W
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49684-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-642-4642
Provider Business Practice Location Address Fax Number:
231-642-4640
Provider Enumeration Date:
10/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WINKLER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST/ DIRECTOR
Authorized Official Telephone Number:
231-642-4642

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6301005613 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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