Provider Demographics
NPI:1124728837
Name:MICHIGAN ANXIETY AND DEPRESSION SERVICES
Entity type:Organization
Organization Name:MICHIGAN ANXIETY AND DEPRESSION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MSW, LMSW-C
Authorized Official - Phone:989-314-1410
Mailing Address - Street 1:208 WILCOX PKWY APT 8
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9799
Mailing Address - Country:US
Mailing Address - Phone:989-314-1410
Mailing Address - Fax:
Practice Address - Street 1:208 WILCOX PKWY APT 8
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-9799
Practice Address - Country:US
Practice Address - Phone:989-314-1410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)