Provider Demographics
NPI:1699058735
Name:LEVICK, KEITH (PHD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:LEVICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32000 NORTHWESTERN HWY STE 128
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1568
Mailing Address - Country:US
Mailing Address - Phone:248-851-0824
Mailing Address - Fax:248-851-9751
Practice Address - Street 1:32000 NORTHWESTERN HWY STE 128
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1568
Practice Address - Country:US
Practice Address - Phone:248-851-0824
Practice Address - Fax:248-851-9751
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010122061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical