| Brooke Osterhoudt, Llc | |
|
4341 Charlotte Hwy Ste 202 Lake Wylie SC 29710-7062 | |
| (303) 408-4455 | |
| Not Available |
| Full Name | Brooke Osterhoudt, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 4341 Charlotte Hwy Ste 202, Lake Wylie, South Carolina |
| Authorized Official Name and Position | Shana Lott (PRACTICE MANAGER) |
| Authorized Official Contact | 3034084455 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brooke Osterhoudt, Llc 16 Hamiltons Ferry Rd Clover SC 29710-8911 Ph: (303) 408-4455 | Brooke Osterhoudt, Llc 4341 Charlotte Hwy Ste 202 Lake Wylie SC 29710-7062 Ph: (303) 408-4455 |
| NPI Number | 1679182984 |
|---|---|
| Provider Enumeration Date | 07/23/2020 |
| Last Update Date | 07/23/2020 |
| Certification Date | 07/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679182984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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