Provider Demographics
NPI:1710174453
Name:APEX BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:APEX BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:734-254-9316
Mailing Address - Street 1:199 N MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1272
Mailing Address - Country:US
Mailing Address - Phone:734-254-9316
Mailing Address - Fax:734-254-8795
Practice Address - Street 1:199 N MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1272
Practice Address - Country:US
Practice Address - Phone:734-254-9316
Practice Address - Fax:734-254-8795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APEX BEHAVIORAL HEALTH PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-26
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N15280Medicare PIN