Provider Demographics
NPI:1295866135
Name:DOWNRIVER MENTAL HEALTH CLINIC PC
Entity Type:Organization
Organization Name:DOWNRIVER MENTAL HEALTH CLINIC PC
Other - Org Name:LIFESTANCE HEALTH, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-399-1493
Mailing Address - Street 1:20500 EUREKA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6394
Mailing Address - Country:US
Mailing Address - Phone:734-285-8282
Mailing Address - Fax:734-281-0402
Practice Address - Street 1:20500 EUREKA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6394
Practice Address - Country:US
Practice Address - Phone:734-285-8282
Practice Address - Fax:734-281-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7509203930OtherBCBS SA