Provider Demographics
NPI:1659569085
Name:SELECTIVE HOME COUNSELING SERVICE
Entity Type:Organization
Organization Name:SELECTIVE HOME COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW-CSW
Authorized Official - Phone:248-830-0800
Mailing Address - Street 1:24100 SOUTHFIELD RD
Mailing Address - Street 2:STE. 320
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2819
Mailing Address - Country:US
Mailing Address - Phone:248-830-0800
Mailing Address - Fax:248-552-9614
Practice Address - Street 1:24100 SOUTHFIELD RD
Practice Address - Street 2:SUITE 320
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2819
Practice Address - Country:US
Practice Address - Phone:248-327-3864
Practice Address - Fax:248-552-9614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801079079320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities