Basic Information
| Provider Information | |||||||||
| NPI: | 1598896532 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOWNRIVER MENTAL HEALTH CLINIC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCED COUNSELING SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20600 EUREKA RD | ||||||||
| Address2: | SUITE 819 | ||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481805343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342858282 | ||||||||
| FaxNumber: | 7342810402 | ||||||||
| Practice Location | |||||||||
| Address1: | 6223 N CANTON CENTER RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481872696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347371200 | ||||||||
| FaxNumber: | 7347371205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BEACH | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER RELATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2482130501 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW ACSW BCD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 7509203950 | 01 | MI | BCBS SA | OTHER |