Provider Demographics
NPI:1689907966
Name:CENTER FOR BEHAVIORAL MEDICINE PLLC
Entity Type:Organization
Organization Name:CENTER FOR BEHAVIORAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERLINDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-245-1660
Mailing Address - Street 1:700 S MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3077
Mailing Address - Country:US
Mailing Address - Phone:810-245-1660
Mailing Address - Fax:810-644-4364
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3077
Practice Address - Country:US
Practice Address - Phone:810-245-1660
Practice Address - Fax:810-644-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty