Provider Demographics
NPI:1619900396
Name:HENRY FORD BEHAVIORAL HEALTH- CLINTON OAKS
Entity Type:Organization
Organization Name:HENRY FORD BEHAVIORAL HEALTH- CLINTON OAKS
Other - Org Name:HENRY FORD HEALTH SYSTEM
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. V. P.
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-874-8714
Mailing Address - Street 1:42633 GARFIELD RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5033
Mailing Address - Country:US
Mailing Address - Phone:586-226-7007
Mailing Address - Fax:586-226-7033
Practice Address - Street 1:42633 GARFIELD RD
Practice Address - Street 2:SUITE 314
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-5033
Practice Address - Country:US
Practice Address - Phone:586-226-7007
Practice Address - Fax:586-226-7033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health