| Healthy Mind Healthy Life | |
|
17515 W 9 Mile Rd Ste 650 Southfield MI 48075-4403 | |
| (248) 963-8189 | |
| (763) 402-7611 |
| Full Name | Healthy Mind Healthy Life |
|---|---|
| Speciality | Clinic/Center |
| Location | 17515 W 9 Mile Rd Ste 650, Southfield, Michigan |
| Authorized Official Name and Position | Larissa Barclay (OWNER) |
| Authorized Official Contact | 2489638189 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Mind Healthy Life 17515 W 9 Mile Rd Ste 650 Southfield MI 48075-4403 Ph: (313) 633-8385 | Healthy Mind Healthy Life 17515 W 9 Mile Rd Ste 650 Southfield MI 48075-4403 Ph: (248) 963-8189 |
| NPI Number | 1932843984 |
|---|---|
| Provider Enumeration Date | 04/26/2022 |
| Last Update Date | 11/08/2023 |
| Certification Date | 11/08/2023 |
| Medicare PECOS PAC ID | 9638546534 |
|---|---|
| Medicare Enrollment ID | O20221107001060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932843984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Larissa Barclay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649473786 PECOS PAC ID: 3870686819 Enrollment ID: I20070906000504 |
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