Provider Demographics
NPI:1902586035
Name:HALCYON THERAPEUTICS PLLC
Entity Type:Organization
Organization Name:HALCYON THERAPEUTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:248-770-3651
Mailing Address - Street 1:200 E BIG BEAVER RD STE 116
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1208
Mailing Address - Country:US
Mailing Address - Phone:248-457-4511
Mailing Address - Fax:248-294-1221
Practice Address - Street 1:200 E BIG BEAVER RD STE 116
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1208
Practice Address - Country:US
Practice Address - Phone:248-457-4511
Practice Address - Fax:248-294-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)