MEDICARE: MY MENTAL WELLNESS, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251V00000X	Voluntary or Charitable Agency
2	261QM0850X	Adult Mental Health Clinic/Center
3	251K00000X	Public Health or Welfare Agency
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1437961513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY MENTAL WELLNESS, INC

Provider Business Mailing Address
First Line	:	14350 TIREMAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-6100
Country	:	US
Telephone Number	:	313-584-4143
Fax Number	:

Provider Business Practice Location Address
First Line	:	14350 TIREMAN ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-6100
Country	:	US
Telephone Number	:	313-584-4143
Fax Number	:	313-914-7187

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	MR. DANISH SYED HASAN
Credential	:
Telephone Number	:	313-584-4143

Provider Enumeration Date	:	01/24/2025
Last Update Date	:	01/24/2025

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Directions to “MY MENTAL WELLNESS, INC ” Practice Location

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