Provider Demographics
NPI:1124365341
Name:PRESTIGE BEHAVIORAL THERAPY DEVELOPMENT CENTER LLC
Entity Type:Organization
Organization Name:PRESTIGE BEHAVIORAL THERAPY DEVELOPMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-492-6007
Mailing Address - Street 1:28249 BELL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5141
Mailing Address - Country:US
Mailing Address - Phone:313-492-6007
Mailing Address - Fax:866-496-9908
Practice Address - Street 1:28249 BELL RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:313-492-6007
Practice Address - Fax:866-496-9908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty