Provider Demographics
NPI:1023238250
Name:ASCENSION EASTWOOD BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:ASCENSION EASTWOOD BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP-CLINICAL SERVICE LINE
Authorized Official - Prefix:
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-753-1169
Mailing Address - Street 1:PO BOX 19117
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4086
Mailing Address - Country:US
Mailing Address - Phone:248-680-8000
Mailing Address - Fax:
Practice Address - Street 1:22255 GREENFIELD ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3700
Practice Address - Country:US
Practice Address - Phone:248-849-3301
Practice Address - Fax:248-849-5349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTWOOD COMMUNITY CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-30
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20477OtherBCBSMI SA NUMBER