Provider Demographics
NPI:1770193815
Name:SANVELLO BEHAVIORAL HEALTH SERVICES OF MICHIGAN, PC
Entity Type:Organization
Organization Name:SANVELLO BEHAVIORAL HEALTH SERVICES OF MICHIGAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-441-0121
Mailing Address - Street 1:150 S 5TH ST STE 825
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-4200
Mailing Address - Country:US
Mailing Address - Phone:877-441-0121
Mailing Address - Fax:
Practice Address - Street 1:150 S 5TH ST STE 825
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-4200
Practice Address - Country:US
Practice Address - Phone:877-441-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANVELLO BEHAVIORAL HEALTH SERVICES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty