| Claystone Clinical Associates Plc | |
|
2401 Camelot Ct Se Ste E Grand Rapids MI 49546-6083 | |
| (616) 949-7460 | |
| (616) 949-3018 |
| Full Name | Claystone Clinical Associates Plc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2401 Camelot Ct Se Ste E, Grand Rapids, Michigan |
| Authorized Official Name and Position | Mary Sue Bock (OFFICE MANAGER) |
| Authorized Official Contact | 6169497460 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Claystone Clinical Associates Plc 2401 Camelot Ct Se Ste E Grand Rapids MI 49546-6083 Ph: (616) 949-7460 | Claystone Clinical Associates Plc 2401 Camelot Ct Se Ste E Grand Rapids MI 49546-6083 Ph: (616) 949-7460 |
| NPI Number | 1619927142 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 07/29/2024 |
| Certification Date | 07/29/2024 |
| Medicare PECOS PAC ID | 1658387014 |
|---|---|
| Medicare Enrollment ID | O20060223000035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619927142 | NPI | - | NPPES |
| Provider Name | Tariq M Faridi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659343879 PECOS PAC ID: 8628084084 Enrollment ID: I20060224000129 |
| Provider Name | Robert W Kopfensteiner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386623643 PECOS PAC ID: 5991711350 Enrollment ID: I20060224000259 |
| Provider Name | Carole Chisholm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356312474 PECOS PAC ID: 4082620448 Enrollment ID: I20060224000297 |
| Provider Name | Omar H Flores |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770735029 PECOS PAC ID: 0840473534 Enrollment ID: I20110317000343 |
| Provider Name | Leigh W Oconnor |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780663138 PECOS PAC ID: 8729094180 Enrollment ID: I20110819000038 |
| Provider Name | Dan S Fogel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619063898 PECOS PAC ID: 5092865477 Enrollment ID: I20130617000652 |
| Provider Name | Erin Meg Elsen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689734642 PECOS PAC ID: 2668744020 Enrollment ID: I20231213000652 |
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