Provider Demographics
NPI:1326235078
Name:APEX BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:APEX BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:313-394-2133
Mailing Address - Street 1:1959 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4125
Mailing Address - Country:US
Mailing Address - Phone:313-394-2133
Mailing Address - Fax:313-394-2135
Practice Address - Street 1:1959 E JEFFERSON AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4125
Practice Address - Country:US
Practice Address - Phone:313-394-2133
Practice Address - Fax:313-394-2135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APEX BEHAVIORAL HEALTH PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-26
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N15280Medicare PIN