Provider Demographics
NPI:1659422483
Name:MICHIGAN BEHAVIORAL HEALTH INSTITUTE
Entity Type:Organization
Organization Name:MICHIGAN BEHAVIORAL HEALTH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADDICTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-922-4900
Mailing Address - Street 1:690 S TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7656
Mailing Address - Country:US
Mailing Address - Phone:989-922-4900
Mailing Address - Fax:989-922-4911
Practice Address - Street 1:690 S TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7656
Practice Address - Country:US
Practice Address - Phone:989-922-4900
Practice Address - Fax:989-922-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301044754261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDF044754OtherBCBS OF MICHIGAN
MI2607301861OtherHEALTH PLUS
MI1006208Medicaid