Provider Demographics
NPI:1700189453
Name:LIVINGSTON COMPREHENSIVE BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:LIVINGSTON COMPREHENSIVE BEHAVIORAL HEALTH, PLLC
Other - Org Name:COMPREHENSIVE BEHAVIORAL HEALTH, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHLACHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-376-5174
Mailing Address - Street 1:714 E GRAND RIVER AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2498
Mailing Address - Country:US
Mailing Address - Phone:517-376-5174
Mailing Address - Fax:
Practice Address - Street 1:714 E GRAND RIVER AVE STE 1
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2498
Practice Address - Country:US
Practice Address - Phone:517-376-5174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010163912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty