Provider Demographics
NPI:1760807671
Name:BEHAVIORAL HEALTH OF ROCHESTER, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH OF ROCHESTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER; SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FARRAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-891-0991
Mailing Address - Street 1:1344 CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1714
Mailing Address - Country:US
Mailing Address - Phone:248-891-0991
Mailing Address - Fax:
Practice Address - Street 1:1344 CHESTNUT CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1714
Practice Address - Country:US
Practice Address - Phone:248-891-0991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093319251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)