Provider Demographics
NPI:1164526380
Name:AMIR EXECUTIVES
Entity Type:Organization
Organization Name:AMIR EXECUTIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSHINGBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-945-0200
Mailing Address - Street 1:19111 WEST TEN MILE ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2443
Mailing Address - Country:US
Mailing Address - Phone:248-945-0200
Mailing Address - Fax:248-945-0204
Practice Address - Street 1:19111 WEST TEN MILE ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2443
Practice Address - Country:US
Practice Address - Phone:248-945-0200
Practice Address - Fax:248-945-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001831101YP2500X
MI68010627491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty