Basic Information
| Provider Information | |||||||||
| NPI: | 1033209366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OPSOMMER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMSW, CAC1 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11735 CRESTVIEW RD | ||||||||
| Address2: | |||||||||
| City: | WHITMORE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481899309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344494607 | ||||||||
| FaxNumber: | 5174853513 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 GENOA BUSINESS PARK DR STE 180 | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481147374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102202787 | ||||||||
| FaxNumber: | 8102202834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6801062764 | MI | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 6801062764 | MI | X | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.