Provider Demographics
NPI:1932259330
Name:EATING DISORDER TREATMENT NETWORK
Entity Type:Organization
Organization Name:EATING DISORDER TREATMENT NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SHIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-531-1479
Mailing Address - Street 1:507 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-2544
Mailing Address - Country:US
Mailing Address - Phone:810-531-1479
Mailing Address - Fax:
Practice Address - Street 1:507 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-2544
Practice Address - Country:US
Practice Address - Phone:810-531-1479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty