Organization
MICHIGAN INSTITUTE OF PERFORMANCE AND HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK S. WELLS LMSW (OWNER/CLINIC DIRECTOR)
(248) 404-7151
Entity
Organization
Contact information
Practice address
43902 WOODWARD AVE STE 230, BLOOMFIELD HILLS, MI 48302-5022
(248) 481-8428
(248) 977-5462
Mailing address
43902 WOODWARD AVE STE 230, BLOOMFIELD HILLS, MI 48302-5022
(248) 481-8428
(248) 977-5462
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VC0005376
—
MI
Enumeration date
09/07/2017
Last updated
02/01/2024
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