Organization
HERON RIDGE ASSOCIATES, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLIOTT RICHELSON M.D. (PRESIDENT, SECRETARY, TREASURER)
(904) 605-4986
Entity
Organization
Contact information
Practice address
31000 TELEGRAPH RD, SUITE 120, BINGHAM FARMS, MI 48025-4360
(248) 594-4991
(248) 391-7478
Mailing address
3694 CLARKSTON RD, SUITE D, CLARKSTON, MI 48348-5213
(248) 693-8880
(248) 391-7478
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
631056
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
463240
VALUE OPTIONS
MI
01
—
750910409
BLUE CROSS BLUE SHIELD
MI
Enumeration date
03/12/2008
Last updated
12/30/2022
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