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General NPI Number Information
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NPI Number | 1417308347
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Entity Type | Organization
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Legal Business Name | PICKENS BEHAVIORAL SERVICES PLLC
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 4084 OKEMOS RD
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City | OKEMOS
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State | MI
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Zip | 48864-3258
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Country | US
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Telephone | 517-347-4848
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Fax | 517-347-4844
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | MASON
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State | MI
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Zip | 48854-0010
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Country | US
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Telephone | 517-676-9788
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Fax | 866-776-7556
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Authorized Official
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Title or Position | OWNER
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Name | NAUDIA N PICKENS
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Credential | MD
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Telephone | 517-347-4848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 4301092517
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License Number State | MI
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