Provider Demographics
NPI:1104391663
Name:ON THE GO BEHAVIORAL HEALTH AND THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ON THE GO BEHAVIORAL HEALTH AND THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:DEVHONJA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-729-1454
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-0820
Mailing Address - Country:US
Mailing Address - Phone:248-729-1454
Mailing Address - Fax:
Practice Address - Street 1:21703 STRATFORD CT
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2558
Practice Address - Country:US
Practice Address - Phone:248-729-1454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty