| Michigan Modern Psychology Group,pllc | |
|
835 Mason St Suite B 220 Dearborn MI 48124-2231 | |
| (313) 561-9064 | |
| (313) 563-4480 |
| Full Name | Michigan Modern Psychology Group,pllc |
|---|---|
| Speciality | Psychologist |
| Location | 835 Mason St, Dearborn, Michigan |
| Authorized Official Name and Position | Manuel A Manrique (DIRECTOR) |
| Authorized Official Contact | 3135619064 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan Modern Psychology Group,pllc 835 Mason St Suite B 220 Dearborn MI 48124-2231 Ph: (313) 561-9064 | Michigan Modern Psychology Group,pllc 835 Mason St Suite B 220 Dearborn MI 48124-2231 Ph: (313) 561-9064 |
| NPI Number | 1447701255 |
|---|---|
| Provider Enumeration Date | 10/17/2016 |
| Last Update Date | 05/29/2024 |
| Certification Date | 05/29/2024 |
| Medicare PECOS PAC ID | 6103162896 |
|---|---|
| Medicare Enrollment ID | O20190117001322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447701255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ted Varkas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548318215 PECOS PAC ID: 0648161786 Enrollment ID: I20040320000237 |
| Provider Name | Christina E Repay |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295781730 PECOS PAC ID: 9133174881 Enrollment ID: I20050316000308 |
| Provider Name | Manuel A Manrique |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588710222 PECOS PAC ID: 5496762759 Enrollment ID: I20060310000213 |
| Provider Name | Nicholas Pikaart |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316580889 PECOS PAC ID: 0840666152 Enrollment ID: I20221011002496 |
| Provider Name | Zeina Angela Yahfoufi |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1467237214 PECOS PAC ID: 7113368655 Enrollment ID: I20240515000128 |
| Provider Name | Lydia Lorenz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750835245 PECOS PAC ID: 7911348164 Enrollment ID: I20240518000203 |
| Provider Name | Brook Mckay |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1316432354 PECOS PAC ID: 9638511157 Enrollment ID: I20240529001566 |
| Provider Name | Lina Darwish |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1629563697 PECOS PAC ID: 0042651234 Enrollment ID: I20240529003718 |
| Provider Name | Joanne Halaweh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811326424 PECOS PAC ID: 0749722312 Enrollment ID: I20240611001620 |
| Provider Name | Sarah E Van Horn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992393904 PECOS PAC ID: 0143762716 Enrollment ID: I20240611001812 |
| Provider Name | Nicholas Paul Zulinski |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1891113627 PECOS PAC ID: 3173065562 Enrollment ID: I20240613001258 |
| Provider Name | Jordan Alexandra Grant |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1720568694 PECOS PAC ID: 5698210755 Enrollment ID: I20240712001782 |
| Provider Name | Kira Nicolle Cook |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1821681628 PECOS PAC ID: 4880139526 Enrollment ID: I20240717002740 |
| Provider Name | Olivia Ann Moquin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447880463 PECOS PAC ID: 2769922970 Enrollment ID: I20240913001529 |
| Provider Name | Alyson Lynn Wilkes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275028722 PECOS PAC ID: 8224579107 Enrollment ID: I20240918003884 |
| Provider Name | Vanessa Gibson |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1770640252 PECOS PAC ID: 0749178150 Enrollment ID: I20240926004175 |
| Provider Name | Ashlee Jean Mosley |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1477816510 PECOS PAC ID: 5193256717 Enrollment ID: I20241007000788 |
| Provider Name | Samantha Leigh Cook |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1821581091 PECOS PAC ID: 5698206266 Enrollment ID: I20241007002790 |
| Provider Name | Alexis Kiana Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609427376 PECOS PAC ID: 3274064746 Enrollment ID: I20241008002972 |
| Provider Name | Charles Vermeulen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578765186 PECOS PAC ID: 1052843364 Enrollment ID: I20241011000599 |
| Provider Name | Sara Pierce |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1003692401 PECOS PAC ID: 6507398815 Enrollment ID: I20241011000611 |
| Provider Name | Lisa Michelle Green |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043795628 PECOS PAC ID: 9537691118 Enrollment ID: I20241021003412 |
| Provider Name | Brian Scott Kitson |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1154801983 PECOS PAC ID: 4183157522 Enrollment ID: I20241024000528 |
| Provider Name | Hillary Easton |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1275130718 PECOS PAC ID: 7618400532 Enrollment ID: I20241031000543 |
| Provider Name | Cheryl Ann Erdman |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1700371598 PECOS PAC ID: 3274069323 Enrollment ID: I20241212000607 |
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