Provider Demographics
NPI:1245804244
Name:DIVERSIFIED BEHAVIORAL HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:DIVERSIFIED BEHAVIORAL HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDADE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-260-0707
Mailing Address - Street 1:3023 LINDSAY LN
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-7780
Mailing Address - Country:US
Mailing Address - Phone:734-260-0707
Mailing Address - Fax:
Practice Address - Street 1:309 MCMORRAN BLVD
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3807
Practice Address - Country:US
Practice Address - Phone:734-260-0707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty