| Depression Healing Clinic | |
|
1200 N West Ave Ste 800 Jackson MI 49202-2179 | |
| (517) 998-4325 | |
| (517) 796-4561 |
| Full Name | Depression Healing Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1200 N West Ave Ste 800, Jackson, Michigan |
| Authorized Official Name and Position | Brittainy A Wagner (BILLER AND CREDENTIALER) |
| Authorized Official Contact | 9032131005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Depression Healing Clinic 1200 N West Ave Ste 800 Jackson MI 49202-2179 Ph: (517) 998-4325 | Depression Healing Clinic 1200 N West Ave Ste 800 Jackson MI 49202-2179 Ph: (517) 998-4325 |
| NPI Number | 1609621143 |
|---|---|
| Provider Enumeration Date | 04/18/2024 |
| Last Update Date | 09/25/2024 |
| Certification Date | 09/25/2024 |
| Medicare PECOS PAC ID | 1052857695 |
|---|---|
| Medicare Enrollment ID | O20240719001221 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609621143 | NPI | - | NPPES |
| Provider Name | Edward L Rodriguez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1477579266 PECOS PAC ID: 5496048266 Enrollment ID: I20160801002499 |
| Provider Name | Sheryl Funston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194201921 PECOS PAC ID: 8325386915 Enrollment ID: I20190206000712 |
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