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1662 E Centre Ave Portage MI 49002-4496 | |
| (269) 321-8564 | |
| Not Available |
| Full Name | |
|---|---|
| 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 |
|---|---|
11000 Optum Cir Eden Prairie MN 55344-2503 Ph: (269) 321-8564 | 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 | Krissa E Kirby |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1386639870 PECOS PAC ID: 1153303326 Enrollment ID: I20160629001848 |
| Provider Name | Michael Charles Anton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104346402 PECOS PAC ID: 3274863790 Enrollment ID: I20190926001646 |
| Provider Name | Nicole Ogier New |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912446048 PECOS PAC ID: 9931504586 Enrollment ID: I20210820000836 |
| 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 |
| Provider Name | Jonathan Bachman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588182711 PECOS PAC ID: 6305272030 Enrollment ID: I20240626002997 |
| Provider Name | Jessica Niland |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457698946 PECOS PAC ID: 3971048828 Enrollment ID: I20240716000133 |
| Provider Name | Tara Ashleigh Bulko |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992438931 PECOS PAC ID: 2961938709 Enrollment ID: I20241204001061 |
Michigan Integrated Therapies Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8080 Moorsbridge Rd Ste 102, Portage, MI 49024 Phone: 269-795-6681 | |
Millicent M Perkins Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5930 Lovers Ln, Portage, MI 49002 Phone: 269-344-9490 Fax: 269-344-8696 | |
Maternal Hope Counseling Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 640 Romence Rd Ste 211a, Portage, MI 49024 Phone: 269-359-7300 | |
Jomie Goerge, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1818 W Centre Ave, Portage, MI 49024 Phone: 269-377-4850 | |
Ascension Medical Group Promed Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8001 Angling Rd, Portage, MI 49024 Phone: 269-321-7090 | |
Southwest Michigan Behavioral Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5250 Lovers Ln Ste 200, Portage, MI 49002 Phone: 800-676-0423 |