Provider Demographics
NPI:1679393797
Name:HURON RIVER PSYCHIATRY PC
Entity type:Organization
Organization Name:HURON RIVER PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-245-7822
Mailing Address - Street 1:3200 W LIBERTY RD STE F1
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9746
Mailing Address - Country:US
Mailing Address - Phone:734-780-7080
Mailing Address - Fax:734-545-8663
Practice Address - Street 1:3200 W LIBERTY RD STE F
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9180
Practice Address - Country:US
Practice Address - Phone:734-780-7080
Practice Address - Fax:734-545-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty