Provider Demographics
NPI:1255087698
Name:ADVANCED MENTAL HEALTH AND TBI SERVICES PLLC
Entity type:Organization
Organization Name:ADVANCED MENTAL HEALTH AND TBI SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:810-844-6146
Mailing Address - Street 1:1384 SEWARD CT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-3790
Mailing Address - Country:US
Mailing Address - Phone:810-844-6146
Mailing Address - Fax:248-282-7022
Practice Address - Street 1:9864 E GRAND RIVER AVE STE 110-131
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1963
Practice Address - Country:US
Practice Address - Phone:810-844-6146
Practice Address - Fax:248-282-7022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED MENTAL HEALTH AND TBI SERVICES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty