Provider Demographics
NPI:1689608804
Name:MICHIGAN ANALYTIC CONSULTANTS OUTPATIENT CLINIC, PC
Entity Type:Organization
Organization Name:MICHIGAN ANALYTIC CONSULTANTS OUTPATIENT CLINIC, PC
Other - Org Name:ADVANCED BEHAVIORAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DIONISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-548-1537
Mailing Address - Street 1:2901 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8548
Mailing Address - Country:US
Mailing Address - Phone:517-548-1537
Mailing Address - Fax:517-548-9399
Practice Address - Street 1:2901 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8548
Practice Address - Country:US
Practice Address - Phone:517-548-1537
Practice Address - Fax:517-548-9399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104033OtherPREFERRED CHOICES
MI750910889OtherBLUE CROSS BLUE SHIELD
MI104033OtherPREFERRED CHOICES