Provider Demographics
NPI:1326599036
Name:MACOMB FAMILY SERVICES, INC
Entity Type:Organization
Organization Name:MACOMB FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-226-3440
Mailing Address - Street 1:36975 UTICA RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1685
Mailing Address - Country:US
Mailing Address - Phone:586-226-3440
Mailing Address - Fax:586-226-3672
Practice Address - Street 1:36975 UTICA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1685
Practice Address - Country:US
Practice Address - Phone:586-226-3440
Practice Address - Fax:586-226-3740
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MACOMB FAMILY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM10460Medicare PIN
MIM10270Medicare PIN