Provider Demographics
NPI:1922042555
Name:EDWARD J. MIKE, PH.D., P.C.
Entity Type:Organization
Organization Name:EDWARD J. MIKE, PH.D., P.C.
Other - Org Name:BRIGHTON COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:989-466-4700
Mailing Address - Street 1:17711 10TH AVE.
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MI
Mailing Address - Zip Code:49665-7930
Mailing Address - Country:US
Mailing Address - Phone:989-466-4700
Mailing Address - Fax:231-743-2106
Practice Address - Street 1:160 EAST WARWICK DRIVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801
Practice Address - Country:US
Practice Address - Phone:989-466-4700
Practice Address - Fax:231-743-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301001900103T00000X, 103TC0700X
MI4101000518106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP33020OtherGROUP #
MI1275571309OtherMEDICARE PERSONAL NPI ENU
MI1024126Medicaid
WI33020001Medicare PIN
MI1275571309OtherMEDICARE PERSONAL NPI ENU
MI0D74506Medicare ID - Type UnspecifiedBILLING NUMBER