| Lesa Brenner Therapy | |
|
3317 Greenleaf Blvd Kalamazoo MI 49008-2516 | |
| (269) 425-3076 | |
| Not Available |
| Full Name | Lesa Brenner Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 3317 Greenleaf Blvd, Kalamazoo, Michigan |
| Authorized Official Name and Position | Mary Beth Houpt (CREDENTIALING) |
| Authorized Official Contact | 5176769797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lesa Brenner Therapy Po Box 10 Mason MI 48854-0010 Ph: () - | Lesa Brenner Therapy 3317 Greenleaf Blvd Kalamazoo MI 49008-2516 Ph: (269) 425-3076 |
| NPI Number | 1780326934 |
|---|---|
| Provider Enumeration Date | 04/08/2022 |
| Last Update Date | 05/04/2023 |
| Certification Date | 05/04/2023 |
| Medicare PECOS PAC ID | 9335526979 |
|---|---|
| Medicare Enrollment ID | O20220519001749 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780326934 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Jessica M Rabe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154957520 PECOS PAC ID: 3971934605 Enrollment ID: I20200513003115 |
| Provider Name | Lesa M Brenner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871051698 PECOS PAC ID: 6406273465 Enrollment ID: I20200904001671 |
| Provider Name | Mary Kathleen Jackson-spaner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487145587 PECOS PAC ID: 0446638852 Enrollment ID: I20220525001789 |
| Provider Name | Amanda Freeman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194267807 PECOS PAC ID: 4183003387 Enrollment ID: I20220617001864 |
| Provider Name | Bryce Wade |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114544913 PECOS PAC ID: 5294188140 Enrollment ID: I20240127000574 |
| Provider Name | Robert Benjamin Weigel |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104343912 PECOS PAC ID: 9436502283 Enrollment ID: I20240127000684 |
| Provider Name | Falon Renee Shepeck |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700365004 PECOS PAC ID: 1052755386 Enrollment ID: I20240214004159 |
| Provider Name | Anne Stefanov |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144640558 PECOS PAC ID: 2769924638 Enrollment ID: I20240606002190 |
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