Provider Demographics
NPI:1821482803
Name:PERSONAL BEST T & C LLC
Entity Type:Organization
Organization Name:PERSONAL BEST T & C LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:ARTINA
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-953-5916
Mailing Address - Street 1:16250 NORTHLAND DR STE 366
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5208
Mailing Address - Country:US
Mailing Address - Phone:313-649-5366
Mailing Address - Fax:313-347-4527
Practice Address - Street 1:16250 NORTHLAND DR STE 366
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5208
Practice Address - Country:US
Practice Address - Phone:313-649-5366
Practice Address - Fax:313-347-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094581251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health