| Legacy Mental Health Pllc | |
|
13741 Pearson St Oak Park MI 48237-2761 | |
| (248) 506-9344 | |
| Not Available |
| Full Name | Legacy Mental Health Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 13741 Pearson St, Oak Park, Michigan |
| Authorized Official Name and Position | Charmeka Whitehead (PSYCHOLOGIST) |
| Authorized Official Contact | 2485069344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legacy Mental Health Pllc 13741 Pearson St Oak Park MI 48237-2761 Ph: (248) 506-9344 | Legacy Mental Health Pllc 13741 Pearson St Oak Park MI 48237-2761 Ph: (248) 506-9344 |
| NPI Number | 1518380666 |
|---|---|
| Provider Enumeration Date | 01/27/2014 |
| Last Update Date | 01/27/2014 |
| Medicare PECOS PAC ID | 9133468002 |
|---|---|
| Medicare Enrollment ID | O20190312000645 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518380666 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 630104388 (Michigan) | Primary |
| Provider Name | Charmeka S Newton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083943203 PECOS PAC ID: 3577791508 Enrollment ID: I20140120000429 |
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