Provider Demographics
NPI:1790072817
Name:WASHTENAW COUNTY COMMUNITY PARTNERSHIP
Entity Type:Organization
Organization Name:WASHTENAW COUNTY COMMUNITY PARTNERSHIP
Other - Org Name:CLEAN TEENS
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SEILER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC NCC CAADC
Authorized Official - Phone:734-646-8426
Mailing Address - Street 1:909 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-2712
Mailing Address - Country:US
Mailing Address - Phone:734-646-8426
Mailing Address - Fax:
Practice Address - Street 1:909 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2712
Practice Address - Country:US
Practice Address - Phone:734-646-8426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-10
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency