NPIMap

Organization Active NPI

Team Mental Health Services Inc.

  • Dentist
  • Detroit, MI
National Provider Identifier
1306383252
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
TEAM MENTAL HEALTH SERVICES INC.
Practice address
3646 Mount Elliott St
Detroit, MI 48207-2311
Phone
(313) 626-2400
Fax
(313) 921-4125
NPI assigned
Jan 30, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Authorized official

Name
Antonio Pollicella
Title
Chief Executive Officer
Phone
(313) 274-3700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary
Public Health DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0001X

Addresses

Primary practice location

3646 Mount Elliott St
Detroit, MI 48207-2311

Mailing address

290 Town Center Dr
Dearborn, MI 48126-2739
Phone (313) 274-3700

Other names 1

  • Team Wellness Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Team Mental Health Services Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

5200 Stecker St
Dearborn, MI 48126
Phone (313) 443-2416

921 Howard St
Dearborn, MI 48124
Phone (313) 274-3700

Practitioners & affiliated clinicians

Practitioners 57

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

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1306383252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 TOWN CENTER DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262739",
            "telephone_number": "313-274-3700",
            "fax_number": "313-274-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3646 MOUNT ELLIOTT ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482072311",
            "telephone_number": "313-626-2400",
            "fax_number": "313-921-4125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEAM MENTAL HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-30",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "POLLICELLA",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "313-274-3700"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Team Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Team Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.