Organization
MIDWEST BEHAVIORAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRIAM JENSEN (OFFICER)
(810) 215-1006
Entity
Organization
Contact information
Practice address
210 W HIGHLAND RD STE 102, HIGHLAND, MI 48357-4573
(248) 529-3167
Mailing address
210 W HIGHLAND RD STE 102, HIGHLAND, MI 48357-4573
(810) 215-1006
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301014043
MI
Other
Enumeration date
06/04/2018
Last updated
07/10/2024
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