Healthcare Provider Details

I. General information

NPI: 1619893849
Provider Name (Legal Business Name): CRYSTAL MARIE LABEAN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30200 TELEGRAPH RD STE 300
BINGHAM FARMS MI
48025-4503
US

IV. Provider business mailing address

30200 TELEGRAPH RD STE 300
BINGHAM FARMS MI
48025-4503
US

V. Phone/Fax

Practice location:
  • Phone: 248-456-8150
  • Fax:
Mailing address:
  • Phone: 248-456-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851122379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: