Provider Demographics
NPI:1568903268
Name:CENTER OF BEHAVIORAL THERAPY, INC.
Entity Type:Organization
Organization Name:CENTER OF BEHAVIORAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNTAY
Authorized Official - Middle Name:LANESHA
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:248-471-5550
Mailing Address - Street 1:28807 8 MILE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2078
Mailing Address - Country:US
Mailing Address - Phone:248-471-5550
Mailing Address - Fax:248-471-5556
Practice Address - Street 1:28807 8 MILE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2078
Practice Address - Country:US
Practice Address - Phone:248-471-5550
Practice Address - Fax:248-471-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI820734261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center