MEDICARE: MS. JOSEPHINE LEFTWICH M.A.,LLP, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301015627	MI
2	101YP2500X	Professional Counselor	6401013851	MI

General Provider Information

NPI Number	:	1225467129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOSEPHINE LEFTWICH M.A.,LLP, LPC

Provider Business Mailing Address
First Line	:	31201 CHICAGO RD S STE A201
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5552
Country	:	US
Telephone Number	:	248-543-0033
Fax Number	:	248-548-5309

Provider Business Practice Location Address
First Line	:	31201 CHICAGO RD S STE A201
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5552
Country	:	US
Telephone Number	:	248-543-0033
Fax Number	:	248-548-5309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2013
Last Update Date	:	09/27/2023

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