| Centennial Park Counseling, Pllc | |
|
2828 Kraft Ave Se Suite 186 Grand Rapids MI 49512 | |
| (616) 949-9550 | |
| (616) 949-9551 |
| Full Name | Centennial Park Counseling, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 2828 Kraft Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Angela Winters (EXECUTIVE ASSISTANT) |
| Authorized Official Contact | 6169499550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centennial Park Counseling, Pllc 2828 Kraft Ave Se Ste 186 Grand Rapids MI 49512-2076 Ph: (616) 949-9550 | Centennial Park Counseling, Pllc 2828 Kraft Ave Se Suite 186 Grand Rapids MI 49512 Ph: (616) 949-9550 |
| NPI Number | 1689814469 |
|---|---|
| Provider Enumeration Date | 03/06/2009 |
| Last Update Date | 06/09/2022 |
| Certification Date | 06/09/2022 |
| Medicare PECOS PAC ID | 6002966207 |
|---|---|
| Medicare Enrollment ID | O20090610000066 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689814469 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 6801063539 (Michigan) | Primary |
| Provider Name | Kurtis Steven Visker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184982787 PECOS PAC ID: 3072767060 Enrollment ID: I20130128000365 |
| Provider Name | Brian W Berce |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740308436 PECOS PAC ID: 2860714797 Enrollment ID: I20141204000964 |
| Provider Name | Joanna Kyrie Gordon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881962413 PECOS PAC ID: 5395005508 Enrollment ID: I20180208001595 |
| Provider Name | Gladiany Torres Perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972995694 PECOS PAC ID: 9032440060 Enrollment ID: I20191007000165 |
| Provider Name | Scott H Glass |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558708891 PECOS PAC ID: 3971835851 Enrollment ID: I20220412000584 |
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