| Child & Family Psychological Services Of Michigan | |
|
1662 E Centre Ave Portage MI 49002-4496 | |
| (269) 321-8564 | |
| Not Available |
| Full Name | Child & Family Psychological Services Of Michigan |
|---|---|
| Speciality | Psychologist |
| Location | 1662 E Centre Ave, Portage, Michigan |
| Authorized Official Name and Position | Leslie Johnson (CEO) |
| Authorized Official Contact | 7045066267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Child & Family Psychological Services Of Michigan 11000 Optum Cir Eden Prairie MN 55344-2503 Ph: (269) 321-8564 | Child & Family Psychological Services Of Michigan 1662 E Centre Ave Portage MI 49002-4496 Ph: (269) 321-8564 |
| NPI Number | 1922860170 |
|---|---|
| Provider Enumeration Date | 01/24/2024 |
| Last Update Date | 03/13/2024 |
| Certification Date | 03/13/2024 |
| Medicare PECOS PAC ID | 0941648463 |
|---|---|
| Medicare Enrollment ID | O20240423001101 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922860170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Michelle A Oursler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992756142 PECOS PAC ID: 7012994718 Enrollment ID: I20040701000059 |
| Provider Name | Denise A Stoddard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790095594 PECOS PAC ID: 7416121090 Enrollment ID: I20111116000497 |
| Provider Name | Aaron J Wilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659662138 PECOS PAC ID: 9638396153 Enrollment ID: I20140807000047 |
| Provider Name | Susan S Pattison |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417098021 PECOS PAC ID: 5991013286 Enrollment ID: I20151007000226 |
| Provider Name | Lauma M Brau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740750918 PECOS PAC ID: 8921342312 Enrollment ID: I20181212001857 |
| Provider Name | Nicole Ogier New |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912446048 PECOS PAC ID: 9931504586 Enrollment ID: I20210820000836 |
| Provider Name | Patricia Criswell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669534129 PECOS PAC ID: 0749636470 Enrollment ID: I20231031003842 |
| Provider Name | Ian Warnsley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1902156359 PECOS PAC ID: 0143678557 Enrollment ID: I20231127000201 |
| Provider Name | Pamela Cook |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184987646 PECOS PAC ID: 6800247610 Enrollment ID: I20240105002124 |
| Provider Name | Caroline Ray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073103628 PECOS PAC ID: 2961853387 Enrollment ID: I20240110003401 |
| Provider Name | Ann Dadah |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780030072 PECOS PAC ID: 8426400029 Enrollment ID: I20240119000418 |
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