Provider Demographics
NPI:1609216829
Name:CUBE
Entity Type:Organization
Organization Name:CUBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:TERLEP
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW LPC
Authorized Official - Phone:586-218-7532
Mailing Address - Street 1:50486 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2327
Mailing Address - Country:US
Mailing Address - Phone:586-883-3877
Mailing Address - Fax:586-598-9641
Practice Address - Street 1:18245 E 10 MILE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5807
Practice Address - Country:US
Practice Address - Phone:586-218-7532
Practice Address - Fax:586-598-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006599251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health