Provider Demographics
NPI:1407631401
Name:MICHIGAN SENIOR MENTAL HEALTH SPECIALISTS LLC
Entity Type:Organization
Organization Name:MICHIGAN SENIOR MENTAL HEALTH SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-533-1476
Mailing Address - Street 1:5448 W FARRAND RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-8204
Mailing Address - Country:US
Mailing Address - Phone:810-533-1476
Mailing Address - Fax:
Practice Address - Street 1:5448 W FARRAND RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-8204
Practice Address - Country:US
Practice Address - Phone:810-533-1476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty