Organization
ABARIS HEALTH
Active
Other names
Great Lakes Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL LUCKI SMITH PHD (PRESIDENT)
(248) 656-8500
Entity
Organization
Contact information
Practice address
1202 WALTON BLVD, SUITE 210, ROCHESTER HILLS, MI 48307-6917
(248) 656-8500
(248) 656-8600
Mailing address
1202 WALTON BLVD, SUITE 210, ROCHESTER HILLS, MI 48307-6917
(248) 656-8500
(248) 656-8600
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5304
MEDICARE PTAN
MI
Enumeration date
09/27/2011
Last updated
10/15/2013
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