Provider Demographics
NPI:1225899107
Name:BIRMINGHAM FAMILY THERAPY CLINIC, INC
Entity Type:Organization
Organization Name:BIRMINGHAM FAMILY THERAPY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STULBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-258-9189
Mailing Address - Street 1:1000 S OLD WOODWARD AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6729
Mailing Address - Country:US
Mailing Address - Phone:248-258-9189
Mailing Address - Fax:
Practice Address - Street 1:1000 S OLD WOODWARD AVE STE 108
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6729
Practice Address - Country:US
Practice Address - Phone:248-258-9189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty