Provider Demographics
NPI:1821025347
Name:APEX BEHAVIORAL HEALTH,PLLC
Entity Type:Organization
Organization Name:APEX BEHAVIORAL HEALTH,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-729-3133
Mailing Address - Street 1:1547 S WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5436
Mailing Address - Country:US
Mailing Address - Phone:734-729-3133
Mailing Address - Fax:734-405-0175
Practice Address - Street 1:1547 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5436
Practice Address - Country:US
Practice Address - Phone:734-729-3133
Practice Address - Fax:734-405-0175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB45550Medicare UPIN
ON15280Medicare ID - Type Unspecified