Organization
DOWNRIVER MENTAL HEALTH CLINIC PC
Active
Other names
Lifestance Health, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN PARDO (CHEIF LEGAL OFFICER)
(206) 399-1493
Entity
Organization
Contact information
Practice address
20500 EUREKA RD, SUITE 200, TAYLOR, MI 48180-6394
(734) 285-8282
(734) 281-0402
Mailing address
20500 EUREKA RD, SUITE 200, TAYLOR, MI 48180-6394
(734) 285-8282
(734) 281-0402
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7509203930
BCBS SA
MI
Enumeration date
03/09/2007
Last updated
01/15/2025
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