Healthcare Provider Details

I. General information

NPI: 1417308347
Provider Name (Legal Business Name): PICKENS BEHAVIORAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4084 OKEMOS RD
OKEMOS MI
48864-3258
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-347-4848
  • Fax: 517-347-4844
Mailing address:
  • Phone: 517-676-9788
  • Fax: 866-776-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number4301092517
License Number StateMI

VIII. Authorized Official

Name: NAUDIA N PICKENS
Title or Position: OWNER
Credential: MD
Phone: 517-347-4848