Provider Demographics
NPI:1710513015
Name:AGENTIC BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:AGENTIC BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-659-2422
Mailing Address - Street 1:21653 PHOENIX DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-6408
Mailing Address - Country:US
Mailing Address - Phone:248-659-2422
Mailing Address - Fax:586-333-5780
Practice Address - Street 1:21653 PHOENIX DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-6408
Practice Address - Country:US
Practice Address - Phone:248-659-2422
Practice Address - Fax:586-333-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty