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Organization
MACOMB FAMILY SERVICES, INC.
Active
Organization
MACOMB FAMILY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OWEN PFAENDTNER (PRESIDENT/CEO)
(586) 336-0422
Entity
Organization
Contact information
Practice address
36975 UTICA RD, SUITE 103, CLINTON TOWNSHIP, MI 48036-1685
(586) 226-3440
(586) 226-3740
Mailing address
36975 UTICA RD, SUITE 103, CLINTON TOWNSHIP, MI 48036-1685
(586) 226-3440
(586) 226-3672
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
N/A
MI
1041C0700X
Clinical Social Worker
Primary
—
—
2084P0800X
Psychiatry Physician
N/A
MI
251C00000X
Developmentally Disabled Services Day Training Agency
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125267
VALUE OPTIONS PIN # - ALL
MI
01
—
13305
CLINTON CIGNA PIN #
MI
01
—
20389
BLUE CROSS S/A
MI
01
—
20528
BLUE CROSS S/A
MI
01
—
20531
BLUE CROSS S/A
MI
01
—
20572
BLUE CROSS S/A
MI
01
—
2066282
ROMEO CIGNA PIN #
MI
01
—
2068754
RICHMOND CIGNA PIN #
MI
05
—
3396315
—
MI
01
—
750910526
RICHMOND BLUE CROSS PIN #
MI
01
—
750910529
ROMEO BLUE CROSS PIN #
MI
01
—
750910612
CLINTON BLUE CROSS PIN #
MI
01
—
750910671
SHELBY BLUE CROSS PIN #
MI
01
—
750910710
BLUE CROSS BLUE SHIELD
MI
01
—
77353
SHELBY CIGNA PIN #
MI
01
—
M07925
HAP PIN #- ALL SITES
MI
Enumeration date
08/02/2005
Last updated
03/28/2017
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