Provider Demographics
NPI:1063780146
Name:BLOOMFIELD COUNSELING,P.C.
Entity type:Organization
Organization Name:BLOOMFIELD COUNSELING,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:EISENSHTADT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-851-7181
Mailing Address - Street 1:5600 W MAPLE RD STE B208
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3707
Mailing Address - Country:US
Mailing Address - Phone:248-851-7181
Mailing Address - Fax:248-851-1223
Practice Address - Street 1:5600 W MAPLE RD
Practice Address - Street 2:SUITE B-208
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3704
Practice Address - Country:US
Practice Address - Phone:248-851-7181
Practice Address - Fax:248-851-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003797103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF34841Medicare PIN