NPIMap

Organization Active NPI

Henry Ford Health Eastwood Behavioral Health

  • Psychologist
  • Saint Clair Shores, MI
National Provider Identifier
1104044676
Registry record updated Jun 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
HENRY FORD HEALTH EASTWOOD BEHAVIORAL HEALTH
Practice address
24055 Jefferson Ave Ste 103
Saint Clair Shores, MI 48080-1511
Phone
(586) 445-2210
Fax
(586) 445-0700
NPI assigned
Apr 23, 2007
Organization subpart
Yes
Parent organization
EASTWOOD COMMUNITY CLINICSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Cebalt
Title
Director
Phone
(313) 874-6764

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X Primary
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X

Addresses

Primary practice location

24055 Jefferson Ave Ste 103
Saint Clair Shores, MI 48080-1511

Mailing address

PO Box 670884
Detroit, MI 48267-0884
Phone (800) 999-5829

Other names 1

  • Eastwood Clinics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eastwood Clinic23 organizations share this tax ID, including this one
Part of
Eastwood Clinic

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

24055 Jefferson Ave
Ste 103
Saint Clair Shores, MI 48080
Phone (586) 445-2210

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781049600000",
    "number": "1104044676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670884",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670884",
            "telephone_number": "800-999-5829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24055 JEFFERSON AVE STE 103",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801511",
            "telephone_number": "586-445-2210",
            "fax_number": "586-445-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY FORD HEALTH EASTWOOD BEHAVIORAL HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EASTWOOD COMMUNITY CLINICS",
        "enumeration_date": "2007-04-23",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A",
        "authorized_official_last_name": "CEBALT",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "313-874-6764"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastwood Clinics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eastwood Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Clair Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.