Provider Demographics
NPI:1205223419
Name:APPLESEED PROFESSIONAL DEVELOPMENT LLC
Entity Type:Organization
Organization Name:APPLESEED PROFESSIONAL DEVELOPMENT LLC
Other - Org Name:THE ANGER DOCTOR
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF BEHAVIORAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANNISE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-733-5142
Mailing Address - Street 1:2000 TOWN CTR
Mailing Address - Street 2:SUITE1900
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 TOWN CTR
Practice Address - Street 2:SUITE1900
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1135
Practice Address - Country:US
Practice Address - Phone:248-733-5142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPLESEED PROFESSIONAL DEVELOPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-26
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)