| The Behavioral Change Clinic Pllc | |
|
200 E Big Beaver Rd Troy MI 48083-1208 | |
| (248) 564-1183 | |
| (248) 458-4578 |
| Full Name | The Behavioral Change Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 E Big Beaver Rd, Troy, Michigan |
| Authorized Official Name and Position | Dominic Christopher Moceri (PRESIDENT, CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 2485641183 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Behavioral Change Clinic Pllc 200 E Big Beaver Rd Troy MI 48083-1208 Ph: (248) 564-1183 | The Behavioral Change Clinic Pllc 200 E Big Beaver Rd Troy MI 48083-1208 Ph: (248) 564-1183 |
| NPI Number | 1073154407 |
|---|---|
| Provider Enumeration Date | 10/07/2019 |
| Last Update Date | 07/20/2020 |
| Certification Date | 07/20/2020 |
| Medicare PECOS PAC ID | 1456773951 |
|---|---|
| Medicare Enrollment ID | O20200629002459 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073154407 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Dominic C Moceri |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346625225 PECOS PAC ID: 3779853718 Enrollment ID: I20170724002603 |
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