Provider Demographics
NPI:1598893141
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:734-285-8282
Mailing Address - Fax:734-281-0402
Practice Address - Street 1:24715 LITTLE MACK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3207
Practice Address - Country:US
Practice Address - Phone:586-777-9000
Practice Address - Fax:586-777-0823
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
MI4441728OtherTEAMSTERS
MI004241F3OtherHAP
MI7509109000OtherBCBS
MI101039OtherVALUE OPTIONS
MI4449395OtherAETNA
MIBM820042OtherMCARE
MI188715000OtherMAGELLAN STATE OF MI
MI=========OtherBCN
MI=========OtherTRICARE
MI4441728OtherTEAMSTERS
MI=========OtherEIN
MI188715000OtherMAGELLAN STATE OF MI
MI511213OtherCARE CHOICES
MI=========OtherPPOM