| Eneziah Walters Lcsw Llc | |
|
2111 University Park Dr Ste 400 Okemos MI 48864-6907 | |
| (517) 512-5289 | |
| Not Available |
| Full Name | Eneziah Walters Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2111 University Park Dr Ste 400, Okemos, Michigan |
| Authorized Official Name and Position | Mary Beth Houpt (CREDENTIALING) |
| Authorized Official Contact | 5176769797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eneziah Walters Lcsw Llc 134 W Maple St Mason MI 48854-1657 Ph: () - | Eneziah Walters Lcsw Llc 2111 University Park Dr Ste 400 Okemos MI 48864-6907 Ph: (517) 512-5289 |
| NPI Number | 1952030587 |
|---|---|
| Provider Enumeration Date | 06/08/2022 |
| Last Update Date | 11/27/2023 |
| Certification Date | 11/27/2023 |
| Medicare PECOS PAC ID | 0941681449 |
|---|---|
| Medicare Enrollment ID | O20220714002902 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952030587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Eneziah Walters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194383802 PECOS PAC ID: 0749690840 Enrollment ID: I20201030001250 |
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