Provider Demographics
NPI:1619315538
Name:APEX BEHAVIORAL HEALTH WESTERN-WAYNE
Entity Type:Organization
Organization Name:APEX BEHAVIORAL HEALTH WESTERN-WAYNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:TAE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-729-3133
Mailing Address - Street 1:1547 S WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5436
Mailing Address - Country:US
Mailing Address - Phone:734-729-3133
Mailing Address - Fax:
Practice Address - Street 1:1547 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5436
Practice Address - Country:US
Practice Address - Phone:734-729-3133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty