Provider Demographics
NPI:1902657406
Name:MICKS, PAIGE (PMHNP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:MICKS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:CECILIA
Other - Last Name:JUST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:2008 LENNON ST
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2008 LENNON ST
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1617
Practice Address - Country:US
Practice Address - Phone:313-820-9735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704349086363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health