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Organization
SOUTHFIELD MENTAL HEALTH ASSOCIATES PC
Active
Organization
SOUTHFIELD MENTAL HEALTH ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE J GUSMAN PHD (OWNER PRESIDENT)
(248) 557-3606
Entity
Organization
Contact information
Practice address
17320 W 12 MILE RD, SUITE 101, SOUTHFIELD, MI 48076-2102
(248) 557-3606
(248) 557-4697
Mailing address
17320 W 12 MILE RD, SUITE 101, SOUTHFIELD, MI 48076-2102
(248) 557-3606
(248) 557-4697
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302643
VALUE OPTIONS
MI
01
—
7509106210
BLUE CROSS MICHIGAN
MI
Enumeration date
02/01/2007
Last updated
08/22/2020
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