Organization
MICHIGAN INSTITUTE OF PERFORMANCE AND HEALTH
Active
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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