Provider Demographics
NPI:1679228233
Name:KMS MENTAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:KMS MENTAL HEALTH AND WELLNESS
Other - Org Name:BLOOMFIELD BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LLP
Authorized Official - Phone:248-854-8659
Mailing Address - Street 1:55097 FALLBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-1852
Mailing Address - Country:US
Mailing Address - Phone:248-854-8659
Mailing Address - Fax:
Practice Address - Street 1:1109 W LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1967
Practice Address - Country:US
Practice Address - Phone:248-854-8659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-12
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)