MEDICARE: BERNADINE PICKETT, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1457824328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNADINE PICKETT, PLLC

Provider Business Mailing Address
First Line	:	63401 DEQUINDRE ROAD
Second Line	:
City	:	WASHINGTON
State	:	MI
Zip	:	48095-2203
Country	:	US
Telephone Number	:	248-752-4881
Fax Number	:	999-999-9999

Provider Business Practice Location Address
First Line	:	455 S LIVERNOIS RD STE C-12
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2582
Country	:	US
Telephone Number	:	248-752-4881
Fax Number	:

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	MRS. BERNADINE A PICKETT
Credential	:	MA LPC NCC
Telephone Number	:	248-752-4881

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	12/18/2023

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