Jeffrey M Last Phd Pllc | |
20300 Civic Center Dr Suite 303 Southfield MI 48076-4105 | |
(248) 559-5774 | |
(248) 559-8776 |
Full Name | Jeffrey M Last Phd Pllc |
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Speciality | Clinic/Center |
Location | 20300 Civic Center Dr, Southfield, Michigan |
Authorized Official Name and Position | Jeffrey Michael Last (OWNER) |
Authorized Official Contact | 2485595774 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Jeffrey M Last Phd Pllc 20300 Civic Center Dr Suite 303 Southfield MI 48076-4105 Ph: (248) 559-5774 | Jeffrey M Last Phd Pllc 20300 Civic Center Dr Suite 303 Southfield MI 48076-4105 Ph: (248) 559-5774 |
NPI Number | 1336445675 |
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Provider Enumeration Date | 02/03/2011 |
Last Update Date | 05/19/2011 |
Medicare PECOS PAC ID | 8921284399 |
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Medicare Enrollment ID | O20110519000277 |
Identifier | Type | State | Issuer |
---|---|---|---|
1336445675 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 6301003183 (Michigan) | Primary |
Provider Name | Jeffrey M Last |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1669585881 PECOS PAC ID: 8426082819 Enrollment ID: I20050926000023 |
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