Healthcare Provider Details

I. General information

NPI: 1003418468
Provider Name (Legal Business Name): MCEVILLY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E LIBERTY ST # ST360
ANN ARBOR MI
48104-2156
US

IV. Provider business mailing address

1210 N CONGRESS ST
YPSILANTI MI
48197-4604
US

V. Phone/Fax

Practice location:
  • Phone: 248-736-7251
  • Fax:
Mailing address:
  • Phone: 248-736-7251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK JAMES MCEVILLY III
Title or Position: THERAPIST/OWNER
Credential: LMSW
Phone: 248-736-7251