| Collective Impact Services Llc | |
|
616 Elizabeth St Petoskey MI 49770 | |
| (231) 758-6776 | |
| Not Available |
| Full Name | Collective Impact Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 616 Elizabeth St, Petoskey, Michigan |
| Authorized Official Name and Position | Julie Clark (OWNER) |
| Authorized Official Contact | 2318386099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Collective Impact Services Llc 616 Elizabeth St Petoskey MI 49770-2704 Ph: () - | Collective Impact Services Llc 616 Elizabeth St Petoskey MI 49770 Ph: (231) 758-6776 |
| NPI Number | 1083317010 |
|---|---|
| Provider Enumeration Date | 03/27/2023 |
| Last Update Date | 04/17/2023 |
| Certification Date | 03/27/2023 |
| Medicare PECOS PAC ID | 8527416866 |
|---|---|
| Medicare Enrollment ID | O20231128001650 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083317010 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Julie Kathleen Clark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164892873 PECOS PAC ID: 1254789597 Enrollment ID: I20231128001698 |
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