Provider Demographics
NPI:1669821625
Name:COLLABORATIVE OASIS DBT LLC
Entity Type:Organization
Organization Name:COLLABORATIVE OASIS DBT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ORSINI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-663-7555
Mailing Address - Street 1:29688 TELEGRAPH RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1362
Mailing Address - Country:US
Mailing Address - Phone:248-663-7555
Mailing Address - Fax:
Practice Address - Street 1:29688 TELEGRAPH RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1362
Practice Address - Country:US
Practice Address - Phone:248-663-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015074103TC0700X
MI68010883121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty