| Delta Psychotherapy Services Llc | |
|
414 S Main St Ste 211a Rochester MI 48307-2070 | |
| (586) 817-1425 | |
| Not Available |
| Full Name | Delta Psychotherapy Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 414 S Main St Ste 211a, Rochester, 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 |
|---|---|
| Delta Psychotherapy Services Llc Po Box 10 Mason MI 48854-0010 Ph: () - | Delta Psychotherapy Services Llc 414 S Main St Ste 211a Rochester MI 48307-2070 Ph: (586) 817-1425 |
| NPI Number | 1215432810 |
|---|---|
| Provider Enumeration Date | 03/26/2018 |
| Last Update Date | 06/30/2021 |
| Certification Date | 06/30/2021 |
| Medicare PECOS PAC ID | 3971867821 |
|---|---|
| Medicare Enrollment ID | O20180501002320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215432810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | 6801098814 (Michigan) | Secondary |
| Provider Name | Michele M Keller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144687021 PECOS PAC ID: 4789948639 Enrollment ID: I20180504001722 |
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