Provider Demographics
NPI:1073658597
Name:COMPREHENSIVE THERAPY CENTER INC
Entity Type:Organization
Organization Name:COMPREHENSIVE THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SILBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:616-559-1054
Mailing Address - Street 1:2505 ARDMORE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4924
Mailing Address - Country:US
Mailing Address - Phone:616-559-1054
Mailing Address - Fax:616-559-1056
Practice Address - Street 1:2505 ARDMORE ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4924
Practice Address - Country:US
Practice Address - Phone:616-559-1054
Practice Address - Fax:616-559-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002435103T00000X
MI5201006103225X00000X
MI7101000658235Z00000X
MI766216251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4866078Medicaid
MIQMXPR0018904OtherMOLINA
MI=========050OtherCOMMUNITY CHOICE