Provider Demographics
NPI:1598746489
Name:CENTRAL THERAPEUTIC SERVICES INC
Entity Type:Organization
Organization Name:CENTRAL THERAPEUTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:K
Authorized Official - Middle Name:G
Authorized Official - Last Name:THIMOTHEOSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-559-4340
Mailing Address - Street 1:17600 W 8 MILE RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4305
Mailing Address - Country:US
Mailing Address - Phone:248-559-4340
Mailing Address - Fax:248-559-1451
Practice Address - Street 1:17600 W 8 MILE RD
Practice Address - Street 2:SUITE #7
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4305
Practice Address - Country:US
Practice Address - Phone:248-559-4340
Practice Address - Fax:248-559-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
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
MI028375OtherVALUE OPTIONS