Provider Demographics
NPI:1013456938
Name:MICHIGAN FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:MICHIGAN FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDIX
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-229-1198
Mailing Address - Street 1:32841 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1771
Mailing Address - Country:US
Mailing Address - Phone:248-733-4899
Mailing Address - Fax:248-733-4208
Practice Address - Street 1:32841 MIDDLEBELT RD
Practice Address - Street 2:SUITE 405
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1771
Practice Address - Country:US
Practice Address - Phone:248-733-4899
Practice Address - Fax:248-733-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010927411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty