Provider Demographics
NPI:1750314027
Name:HURON VALLEY CONSULTATION CENTER INC
Entity Type:Organization
Organization Name:HURON VALLEY CONSULTATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEX
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:734-662-6300
Mailing Address - Street 1:15 RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2974
Mailing Address - Country:US
Mailing Address - Phone:734-662-6300
Mailing Address - Fax:734-662-3365
Practice Address - Street 1:15 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2974
Practice Address - Country:US
Practice Address - Phone:734-662-6300
Practice Address - Fax:734-662-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI067290OtherVALUE OPTIONS
MIP46215OtherBLUECARE NETWORK
MIBM810003OtherMCARE
MI0M07270Medicare ID - Type Unspecified