Organization
PORT HURON COUNSELING BEHAVIORAL SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY TAGLIONE (BILLING CO)
(734) 414-0754
Entity
Organization
Contact information
Practice address
309 MCMORRAN BLVD, PORT HURON, MI 48060-3807
(810) 488-7974
Mailing address
42928 VERSAILLES RD, CANTON, MI 48187-2344
(810) 488-7974
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301055449
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2607611202
BLUE CROSS
MI
Enumeration date
12/03/2008
Last updated
12/03/2008
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