Healthcare Provider Details

I. General information

NPI: 1497294805
Provider Name (Legal Business Name): J&E PICKENS FAMILY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39245 NOTTINGHAM ST
WESTLAND MI
48186-3729
US

IV. Provider business mailing address

39245 NOTTINGHAM ST
WESTLAND MI
48186-3729
US

V. Phone/Fax

Practice location:
  • Phone: 734-992-7212
  • Fax: 734-629-4773
Mailing address:
  • Phone: 734-992-7212
  • Fax: 734-629-4773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MICHAEL D PICKENS
Title or Position: OWNER
Credential:
Phone: 734-992-7212