| Apex Behavioral Health Western Wayne | |
|
1547 S Wayne Rd Westland MI 48186-5436 | |
| (734) 729-3133 | |
| Not Available |
| Full Name | Apex Behavioral Health Western Wayne |
|---|---|
| Speciality | Social Worker |
| Location | 1547 S Wayne Rd, Westland, Michigan |
| Authorized Official Name and Position | Jill Blackson (COORDINATOR) |
| Authorized Official Contact | 7344050175 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Apex Behavioral Health Western Wayne 1547 S Wayne Rd Westland MI 48186-5436 Ph: (734) 729-3133 | Apex Behavioral Health Western Wayne 1547 S Wayne Rd Westland MI 48186-5436 Ph: (734) 729-3133 |
| NPI Number | 1962779710 |
|---|---|
| Provider Enumeration Date | 11/22/2011 |
| Last Update Date | 11/22/2011 |
| Medicare PECOS PAC ID | 4183885593 |
|---|---|
| Medicare Enrollment ID | O20120411000775 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962779710 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tae W Park |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538133020 PECOS PAC ID: 5799682704 Enrollment ID: I20031223000319 |
| Provider Name | James B Knowles |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679513568 PECOS PAC ID: 5698748382 Enrollment ID: I20040819000909 |
| Provider Name | Michael L Tucker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114054780 PECOS PAC ID: 5395840003 Enrollment ID: I20070424000654 |
| Provider Name | Kelly R Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932399169 PECOS PAC ID: 1951495803 Enrollment ID: I20070921000836 |
| Provider Name | Keon Chang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669451738 PECOS PAC ID: 4688560402 Enrollment ID: I20080822000587 |
| Provider Name | Alicia Shamblin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548407141 PECOS PAC ID: 6507913167 Enrollment ID: I20100602000041 |
| Provider Name | Thomas E Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639436173 PECOS PAC ID: 8325934136 Enrollment ID: I20120808000251 |
| Provider Name | Stacey L Porreca |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396905386 PECOS PAC ID: 0941446033 Enrollment ID: I20130416000247 |
| Provider Name | Marie A Neid |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649598236 PECOS PAC ID: 7113999541 Enrollment ID: I20171020002490 |
| Provider Name | Kathleen S Tayeh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548760036 PECOS PAC ID: 2365871191 Enrollment ID: I20200331000397 |
| Provider Name | Elizabeth I Yaklin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528381860 PECOS PAC ID: 0941617468 Enrollment ID: I20210330001818 |
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