Provider Demographics
NPI:1346378981
Name:DOWNRIVER MENTAL HEALTH CLINIC PC
Entity Type:Organization
Organization Name:DOWNRIVER MENTAL HEALTH CLINIC PC
Other - Org Name:ADVANCED COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW ACSW BCD
Authorized Official - Phone:248-213-0501
Mailing Address - Street 1:20600 EUREKA RD
Mailing Address - Street 2:SUITE 819
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-5343
Mailing Address - Country:US
Mailing Address - Phone:734-285-2828
Mailing Address - Fax:734-281-0402
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 550
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-213-0501
Practice Address - Fax:248-213-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI511213OtherCARE CHOICES
MIBM820042OtherMCARE
MI101039OtherVALUE OPTIONS
MI90197000OtherMAGELLAN STATE OF MI
MI4449395OtherAETNA
MI7509108970OtherBCBS
MI004241F3OtherHAP
MI4441728OtherTEAMSTERS
MI=========OtherTRICARE
MI=========OtherEIN
MI511213OtherCARE CHOICES
MI=========OtherPPOM
MI7509108970OtherBCBS
MI=========OtherBCN
0Q24542Medicare ID - Type Unspecified