Provider Demographics
NPI:1922811587
Name:CLC BEHAVIORAL HEALTH, PLLC
Entity type:Organization
Organization Name:CLC BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CASSIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPANALE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP
Authorized Official - Phone:248-671-4383
Mailing Address - Street 1:3508 ERIE DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1522
Mailing Address - Country:US
Mailing Address - Phone:248-671-4383
Mailing Address - Fax:
Practice Address - Street 1:370 E MAPLE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6303
Practice Address - Country:US
Practice Address - Phone:248-671-4383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty