Provider Demographics
NPI:1033835707
Name:ACES PEDIATRIC BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:ACES PEDIATRIC BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMYRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:231-268-1149
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-0122
Mailing Address - Country:US
Mailing Address - Phone:231-268-1149
Mailing Address - Fax:
Practice Address - Street 1:10823 N STRAITS HWY STE B
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-9077
Practice Address - Country:US
Practice Address - Phone:231-268-1149
Practice Address - Fax:231-268-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265098693Medicaid