Provider Demographics
NPI:1043373137
Name:SAMARITAN COUNSELING CENTER OF SOUTHEASTERN MICHIGAN
Entity Type:Organization
Organization Name:SAMARITAN COUNSELING CENTER OF SOUTHEASTERN MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:248-474-4701
Mailing Address - Street 1:29887 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1309
Mailing Address - Country:US
Mailing Address - Phone:248-474-4701
Mailing Address - Fax:248-474-1518
Practice Address - Street 1:29887 W 11 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1309
Practice Address - Country:US
Practice Address - Phone:248-474-4701
Practice Address - Fax:248-474-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)