Provider Demographics
NPI:1144421314
Name:MICHIGAN BEHAVIORAL HEALTH INSTITUTE INC.
Entity Type:Organization
Organization Name:MICHIGAN BEHAVIORAL HEALTH INSTITUTE INC.
Other - Org Name:MBHI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-893-2121
Mailing Address - Street 1:863 N PINE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-2159
Mailing Address - Country:US
Mailing Address - Phone:989-893-2121
Mailing Address - Fax:989-893-2177
Practice Address - Street 1:863 N PINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-2159
Practice Address - Country:US
Practice Address - Phone:989-893-2121
Practice Address - Fax:989-893-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI090066101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty