Basic Information
| Provider Information | |||||||||
| NPI: | 1609857978 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRAINING & TREATMENT INNOVATIONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 S LAPEER RD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483716108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489699932 | ||||||||
| FaxNumber: | 2489693006 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 S LAPEER RD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483716108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489699932 | ||||||||
| FaxNumber: | 2489693006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 12/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | KISS-WILSON | ||||||||
| AuthorizedOfficialFirstName: | JACQUELINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2489699932 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 4703537 | 05 | MI | MEDICAID | 4958492 | 05 | MI | MEDICAID | 4646501 | 05 | MI | MEDICAID | 4703493 | 05 | MI | MEDICAID | 4940694 | 05 | MI | MEDICAID | 4279879 | 05 | MI | MEDICAID | 4958509 | 05 | MI | MEDICAID |