Provider Demographics
NPI:1528337706
Name:BEDFORD BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:BEDFORD BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:734-807-0162
Mailing Address - Street 1:8336 MONROE RD.
Mailing Address - Street 2:RM 120
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9339
Mailing Address - Country:US
Mailing Address - Phone:734-807-0162
Mailing Address - Fax:888-700-7159
Practice Address - Street 1:8336 MONROE RD.
Practice Address - Street 2:RM 120
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9339
Practice Address - Country:US
Practice Address - Phone:734-807-0162
Practice Address - Fax:888-700-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-18
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty