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705 S Main St Ste 280 Plymouth MI 48170-1060 | |
| (734) 454-3560 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 705 S Main St Ste 280, Plymouth, Michigan |
| Authorized Official Name and Position | Leslie Johnson (CEO) |
| Authorized Official Contact | 7045066267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
11000 Optum Cir Eden Prairie MN 55344-2503 Ph: (248) 594-4991 | 705 S Main St Ste 280 Plymouth MI 48170-1060 Ph: (734) 454-3560 |
| NPI Number | 1306616735 |
|---|---|
| Provider Enumeration Date | 01/05/2024 |
| Last Update Date | 03/13/2024 |
| Certification Date | 03/13/2024 |
| Medicare PECOS PAC ID | 0941648463 |
|---|---|
| Medicare Enrollment ID | O20240412001576 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306616735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | William L Guy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295748101 PECOS PAC ID: 3870581861 Enrollment ID: I20040506000688 |
| Provider Name | Cheryl Ann Albertson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245443597 PECOS PAC ID: 6901879501 Enrollment ID: I20040812001224 |
| Provider Name | Peter C Wolf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124010137 PECOS PAC ID: 5496779241 Enrollment ID: I20060119000205 |
| Provider Name | Derrick O Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417960030 PECOS PAC ID: 4183621766 Enrollment ID: I20061024000170 |
| Provider Name | Kathleen P Irvin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033215058 PECOS PAC ID: 4284771932 Enrollment ID: I20091028000653 |
| Provider Name | Andrea N Morrison |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407145030 PECOS PAC ID: 6709054836 Enrollment ID: I20110715000601 |
| Provider Name | David M Devellis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851616197 PECOS PAC ID: 6305063652 Enrollment ID: I20140808001860 |
| Provider Name | Michelle L Kazmierski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639530967 PECOS PAC ID: 0244537488 Enrollment ID: I20160401001259 |
| Provider Name | Raphael D Levin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083060313 PECOS PAC ID: 4183914112 Enrollment ID: I20160603001366 |
| Provider Name | Renee M Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538725106 PECOS PAC ID: 9931433869 Enrollment ID: I20190627000478 |
| Provider Name | Frances L Cartwright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629199823 PECOS PAC ID: 7517041353 Enrollment ID: I20190702002630 |
| Provider Name | Michael Charles Anton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104346402 PECOS PAC ID: 3274863790 Enrollment ID: I20190926001646 |
| Provider Name | Lisa Quaglia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992298798 PECOS PAC ID: 9436558889 Enrollment ID: I20210604001356 |
| Provider Name | Angelique Ortiz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316529431 PECOS PAC ID: 9739589789 Enrollment ID: I20210611001805 |
| Provider Name | Mansi Sharadhumar Mehta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609393735 PECOS PAC ID: 4486911005 Enrollment ID: I20210722002098 |
| Provider Name | Sherry Lynn Mcclelland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154675205 PECOS PAC ID: 3375941057 Enrollment ID: I20211011001291 |
| Provider Name | Jennifer Vogt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1255797338 PECOS PAC ID: 4486001807 Enrollment ID: I20231107001793 |
| Provider Name | Lana Joan Hull |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518404029 PECOS PAC ID: 9234587254 Enrollment ID: I20231214001540 |
| Provider Name | Bethany Moulton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801373568 PECOS PAC ID: 5193175537 Enrollment ID: I20231227000935 |
| Provider Name | Lee Theodore Dreps |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952649865 PECOS PAC ID: 0749628543 Enrollment ID: I20240328003868 |
| Provider Name | Ellen Tobin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801383989 PECOS PAC ID: 2264977909 Enrollment ID: I20240717002672 |
| Provider Name | Armando Tena |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003863903 PECOS PAC ID: 7315483674 Enrollment ID: I20240723000989 |
| Provider Name | Megan Gandolfi |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922501543 PECOS PAC ID: 0840737417 Enrollment ID: I20240731002602 |
| Provider Name | Hannah Emily Birkett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982216552 PECOS PAC ID: 9830503044 Enrollment ID: I20241024001461 |
Steven J Ceresnie Phd Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 199 N Main St, Plymouth, MI 48170 Phone: 734-453-9290 Fax: 734-453-9293 | |
Mkaye Counseling, Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 600 N Evergreen St, Plymouth, MI 48170 Phone: 734-277-1810 | |
Access Behavioral Associates Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 42189 Ann Arbor Rd E, Plymouth, MI 48170 Phone: 734-453-5603 Fax: 734-453-5619 | |
Mangin Psychological Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 42233 Ann Arbor Rd E, Plymouth, MI 48170 Phone: 734-386-0452 Fax: 734-419-9023 | |
Evergreen Hope Counseling, Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1176 S Main St Ste 201, Plymouth, MI 48170 Phone: 920-246-1465 | |
Unmasking The Fear Counseling Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9341 N Haggerty Rd, Plymouth, MI 48170 Phone: 313-570-0636 |