Healthcare Provider Details

I. General information

NPI: 1194386805
Provider Name (Legal Business Name): MELISSA S PICKETT LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 W BIG BEAVER RD STE 780
TROY MI
48084-4745
US

IV. Provider business mailing address

9070 CHAMBORD DR
YPSILANTI MI
48197-9281
US

V. Phone/Fax

Practice location:
  • Phone: 248-264-3463
  • Fax:
Mailing address:
  • Phone: 419-403-8687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851120090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: