| Alliance Behavioral Care Llc | |
|
8752 Lilly Dr Ypsilanti MI 48197-9655 | |
| (734) 635-3499 | |
| Not Available |
| Full Name | Alliance Behavioral Care Llc |
|---|---|
| Speciality | Social Worker |
| Location | 8752 Lilly Dr, Ypsilanti, Michigan |
| Authorized Official Name and Position | Latasha Marie Shannon (CEO) |
| Authorized Official Contact | 7346353499 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alliance Behavioral Care Llc 8752 Lilly Dr Ypsilanti MI 48197-9655 Ph: (734) 635-3499 | Alliance Behavioral Care Llc 8752 Lilly Dr Ypsilanti MI 48197-9655 Ph: (734) 635-3499 |
| NPI Number | 1275178402 |
|---|---|
| Provider Enumeration Date | 11/12/2019 |
| Last Update Date | 03/06/2020 |
| Certification Date | 03/06/2020 |
| Medicare PECOS PAC ID | 5294162053 |
|---|---|
| Medicare Enrollment ID | O20200218000481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275178402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Latasha Shannon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669754271 PECOS PAC ID: 9335397330 Enrollment ID: I20120917000784 |
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