Provider Demographics
NPI:1114317476
Name:ADAMS BEHAVIORAL & PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:ADAMS BEHAVIORAL & PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-402-7779
Mailing Address - Street 1:17340 W 12 MILE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-6322
Mailing Address - Country:US
Mailing Address - Phone:313-402-7779
Mailing Address - Fax:
Practice Address - Street 1:17340 W 12 MILE RD STE 205
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6322
Practice Address - Country:US
Practice Address - Phone:313-402-7779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801088547261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)