Provider Demographics
NPI:1043731573
Name:FULL CIRCLE BEHAVIORAL HEALTH, PC
Entity Type:Organization
Organization Name:FULL CIRCLE BEHAVIORAL HEALTH, PC
Other - Org Name:FULL CIRCLE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/LIMITED LICENSED PSYCHOLO
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:248-722-2653
Mailing Address - Street 1:3467 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1315
Mailing Address - Country:US
Mailing Address - Phone:248-722-2653
Mailing Address - Fax:248-682-0612
Practice Address - Street 1:3467 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1315
Practice Address - Country:US
Practice Address - Phone:248-722-2653
Practice Address - Fax:248-682-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011714101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty