| Emerge Teletherapy Practice | |
|
17145 Bonstelle Ave Southfield MI 48075-3470 | |
| (248) 945-2095 | |
| Not Available |
| Full Name | Emerge Teletherapy Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 17145 Bonstelle Ave, Southfield, Michigan |
| Authorized Official Name and Position | Mia Michelle Hall (CLINICAL MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 2489452095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emerge Teletherapy Practice 17145 Bonstelle Ave Southfield MI 48075-3470 Ph: (248) 996-4917 | Emerge Teletherapy Practice 17145 Bonstelle Ave Southfield MI 48075-3470 Ph: (248) 945-2095 |
| NPI Number | 1699408674 |
|---|---|
| Provider Enumeration Date | 07/06/2022 |
| Last Update Date | 09/28/2023 |
| Certification Date | 09/28/2023 |
| Medicare PECOS PAC ID | 4981058732 |
|---|---|
| Medicare Enrollment ID | O20230927001674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699408674 | NPI | - | NPPES |
| Provider Name | Mia M Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629437769 PECOS PAC ID: 9931555232 Enrollment ID: I20231023002720 |
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