Organization
EASTER SEALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAYLA GLASS (BEHAVIORAL HEALTH CLINICIAN)
(248) 763-2399
Entity
Organization
Contact information
Practice address
24445 NORTHWESTERN HWY, SUITE 100, SOUTHFIELD, MI 48075-6501
(248) 483-7804
(248) 483-7868
Mailing address
24445 NORTHWESTERN HWY, SUITE 100, SOUTHFIELD, MI 48075-6501
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6301015758
MI
Other
Enumeration date
02/26/2014
Last updated
02/26/2014
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