Provider Demographics
NPI:1669491098
Name:PSYCHIATRY AND BEHAVIORAL MEDICINE PROFESSIONALS
Entity Type:Organization
Organization Name:PSYCHIATRY AND BEHAVIORAL MEDICINE PROFESSIONALS
Other - Org Name:UNIVERSITY PSYCHIATRIC CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TANCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-577-0215
Mailing Address - Street 1:3800 WOODWARD AVE
Mailing Address - Street 2:SUITE 702
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2061
Mailing Address - Country:US
Mailing Address - Phone:313-262-1257
Mailing Address - Fax:313-262-1238
Practice Address - Street 1:2751 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4180
Practice Address - Country:US
Practice Address - Phone:888-362-7792
Practice Address - Fax:313-993-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty