Provider Demographics
NPI:1407648959
Name:MATTIOLI MENTAL HEALTH CLINIC PLLC
Entity type:Organization
Organization Name:MATTIOLI MENTAL HEALTH CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:MATTIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-498-9455
Mailing Address - Street 1:10524 GRAND RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9559
Mailing Address - Country:US
Mailing Address - Phone:810-498-9455
Mailing Address - Fax:
Practice Address - Street 1:10524 GRAND RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9559
Practice Address - Country:US
Practice Address - Phone:810-498-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health