| Deerfield Counseling Llc | |
|
5900 Portage Rd Portage MI 49002-1774 | |
| (269) 718-3366 | |
| Not Available |
| Full Name | Deerfield Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 5900 Portage Rd, Portage, Michigan |
| Authorized Official Name and Position | Mary Beth Houpt (CREDENTIALING) |
| Authorized Official Contact | 5176769788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deerfield Counseling Llc Po Box 10 Mason MI 48854-0010 Ph: () - | Deerfield Counseling Llc 5900 Portage Rd Portage MI 49002-1774 Ph: (269) 718-3366 |
| NPI Number | 1992292338 |
|---|---|
| Provider Enumeration Date | 04/20/2018 |
| Last Update Date | 03/24/2022 |
| Certification Date | 03/24/2022 |
| Medicare PECOS PAC ID | 2062861917 |
|---|---|
| Medicare Enrollment ID | O20231218001972 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992292338 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| 103TC1900X | Psychologist - Counseling | 6301009891 (Michigan) | Secondary |
| Provider Name | Charles Thomas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801271416 PECOS PAC ID: 3971952821 Enrollment ID: I20231218002032 |
| Provider Name | Marissa Cooney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891233532 PECOS PAC ID: 1759732845 Enrollment ID: I20240112003822 |
| Provider Name | Kenneth Blair Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831823665 PECOS PAC ID: 5193177301 Enrollment ID: I20240123003002 |
| Provider Name | Anastasia Stalias-tibbs |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699101865 PECOS PAC ID: 1951742394 Enrollment ID: I20240515004334 |
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