Provider Demographics
NPI:1750620225
Name:MENTAL HEALTH MICHIGAN PLLC
Entity type:Organization
Organization Name:MENTAL HEALTH MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD, NP, LMSW
Authorized Official - Phone:248-759-4941
Mailing Address - Street 1:671 W BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6081
Mailing Address - Country:US
Mailing Address - Phone:248-759-4941
Mailing Address - Fax:866-703-7884
Practice Address - Street 1:671 W BLUFF CT
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6081
Practice Address - Country:US
Practice Address - Phone:248-759-4941
Practice Address - Fax:866-703-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704156612363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26216Medicare UPIN