Provider Demographics
NPI:1164783965
Name:EATON BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:EATON BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-541-2633
Mailing Address - Street 1:1033 HEALTHCARE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1058
Mailing Address - Country:US
Mailing Address - Phone:517-543-2580
Mailing Address - Fax:517-543-8191
Practice Address - Street 1:1033 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1058
Practice Address - Country:US
Practice Address - Phone:517-543-2580
Practice Address - Fax:517-543-8191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARRY-EATON HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009338251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health