NPIMap

Organization Active NPI

Landmark Therapy LLC

  • Social Worker
  • Southfield, MI
National Provider Identifier
1225520133
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Legal business name
LANDMARK THERAPY LLC
Practice address
28330 Franklin River Dr
Southfield, MI 48034-5479
Phone
(810) 875-9186
NPI assigned
Jun 6, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Council Wickersham, LMSWNPI 1396106225
Title
Clinical Director
Phone
(248) 931-0016

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X Primary

Addresses

Primary practice location

28330 Franklin River Dr
Southfield, MI 48034-5479

Mailing address

1848 Humphrey Ave
Birmingham, MI 48009-7153
Phone (810) 875-9186

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181019000600 MI Part B Supplier - Clinic/Group Practice 2264785302 Receives reassigned benefits from 4 practitioners
Practice locations: Southfield, MI

National Provider Directory

National Provider Directory

Locations

28330 Franklin Rd
Apt 6
Southfield, MI 48034
Phone (248) 931-0016

28330 Franklin Rd
Southfield, MI 48034
Phone (248) 931-0016

2605 Crooks Rd
Ste B
Troy, MI 48084
Phone (248) 558-2052

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528243200000",
    "number": "1225520133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 HUMPHREY AVE",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480097153",
            "telephone_number": "810-875-9186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28330 FRANKLIN RIVER DR",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480345479",
            "telephone_number": "810-875-9186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANDMARK THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-06",
        "last_updated": "2018-06-06",
        "status": "A",
        "authorized_official_last_name": "WICKERSHAM",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "COUNCIL",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "248-931-0016",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.