Provider Demographics
NPI:1497932800
Name:SELF AND FAMILY ENTERPRISES L L C
Entity Type:Organization
Organization Name:SELF AND FAMILY ENTERPRISES L L C
Other - Org Name:SELF AND FAMILY BEHAVIORAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:LOWE
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-586-0031
Mailing Address - Street 1:7521 N TELEGRAPH RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWPORT
Mailing Address - State:MI
Mailing Address - Zip Code:48166-9398
Mailing Address - Country:US
Mailing Address - Phone:734-586-0031
Mailing Address - Fax:734-586-0032
Practice Address - Street 1:7521 N TELEGRAPH RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWPORT
Practice Address - State:MI
Practice Address - Zip Code:48166-9398
Practice Address - Country:US
Practice Address - Phone:734-586-0031
Practice Address - Fax:734-586-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty