| Altus Home Counseling And Behavioral Services Llc | |
|
2785 E Grand Blvd Ste 536 Detroit MI 48211-2003 | |
| (586) 359-5269 | |
| Not Available |
| Full Name | Altus Home Counseling And Behavioral Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2785 E Grand Blvd Ste 536, Detroit, Michigan |
| Authorized Official Name and Position | Chanel Johnson (CEO) |
| Authorized Official Contact | 5863595269 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Altus Home Counseling And Behavioral Services Llc 2785 E Grand Blvd Ste 536 Detroit MI 48211-2003 Ph: () - | Altus Home Counseling And Behavioral Services Llc 2785 E Grand Blvd Ste 536 Detroit MI 48211-2003 Ph: (586) 359-5269 |
| NPI Number | 1477128676 |
|---|---|
| Provider Enumeration Date | 05/21/2021 |
| Last Update Date | 08/31/2023 |
| Certification Date | 08/31/2023 |
| Medicare PECOS PAC ID | 2961857222 |
|---|---|
| Medicare Enrollment ID | O20231212001764 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477128676 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Secondary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Lakeita Charmain Cobb |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740702042 PECOS PAC ID: 8921457201 Enrollment ID: I20231212002018 |
| Provider Name | David Alexander Bullock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053960047 PECOS PAC ID: 5395194567 Enrollment ID: I20231213001483 |
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