| Awaken Mind & Body | |
|
612 Miller Dr Grand Haven MI 49417 | |
| (616) 287-2833 | |
| Not Available |
| Full Name | Awaken Mind & Body |
|---|---|
| Speciality | Counselor |
| Location | 612 Miller Dr, Grand Haven, Michigan |
| Authorized Official Name and Position | Kristen Kennedy (CO-OWNER) |
| Authorized Official Contact | 6162872833 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Awaken Mind & Body 4441 Grand Haven Rd Ste A Norton Shores MI 49441-5507 Ph: (616) 414-5506 | Awaken Mind & Body 612 Miller Dr Grand Haven MI 49417 Ph: (616) 287-2833 |
| NPI Number | 1861110207 |
|---|---|
| Provider Enumeration Date | 08/22/2022 |
| Last Update Date | 02/28/2024 |
| Certification Date | 02/28/2024 |
| Medicare PECOS PAC ID | 5991150039 |
|---|---|
| Medicare Enrollment ID | O20231010003602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861110207 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Maria Herrala |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861971145 PECOS PAC ID: 0648634790 Enrollment ID: I20230908000359 |
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