Provider Demographics
NPI:1649757626
Name:HEALTHY MINDS, HEALTHY HEARTS
Entity Type:Organization
Organization Name:HEALTHY MINDS, HEALTHY HEARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MALLPC, M-DIV
Authorized Official - Phone:248-796-2822
Mailing Address - Street 1:1885 MIDCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1138
Mailing Address - Country:US
Mailing Address - Phone:248-796-2822
Mailing Address - Fax:248-327-0333
Practice Address - Street 1:32961 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1773
Practice Address - Country:US
Practice Address - Phone:248-796-2822
Practice Address - Fax:248-327-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011114101YM0800X, 225XM0800X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty