Provider Demographics
NPI:1275671968
Name:NORTHWESTERN PSYCHIATRY & COUNSELING CENTER PC
Entity Type:Organization
Organization Name:NORTHWESTERN PSYCHIATRY & COUNSELING CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHU
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDIRATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-945-9370
Mailing Address - Street 1:26699 W 12 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1578
Mailing Address - Country:US
Mailing Address - Phone:248-945-9370
Mailing Address - Fax:248-945-9377
Practice Address - Street 1:26699 W 12 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1578
Practice Address - Country:US
Practice Address - Phone:248-945-9370
Practice Address - Fax:248-945-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM0485202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2606351352OtherBCBCM
MI=========OtherFEDERAL TAX ID
MI2606351352OtherBCBCM
MI0N25240Medicare ID - Type Unspecified
MI0P41420Medicare PIN