| Engedi Therapy Llc | |
|
30100 Telegraph Rd Ste 474 Bingham Farms MI 48025-5810 | |
| (248) 914-4607 | |
| Not Available |
| Full Name | Engedi Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 30100 Telegraph Rd Ste 474, Bingham Farms, Michigan |
| Authorized Official Name and Position | Joanna Kyrie Brown-gordon (OWNER/THERAPIST) |
| Authorized Official Contact | 2489144607 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Engedi Therapy Llc 30100 Telegraph Rd Ste 474 Bingham Farms MI 48025-5810 Ph: (248) 914-4607 | Engedi Therapy Llc 30100 Telegraph Rd Ste 474 Bingham Farms MI 48025-5810 Ph: (248) 914-4607 |
| NPI Number | 1316563950 |
|---|---|
| Provider Enumeration Date | 06/19/2020 |
| Last Update Date | 08/16/2023 |
| Certification Date | 08/16/2023 |
| Medicare PECOS PAC ID | 8426435108 |
|---|---|
| Medicare Enrollment ID | O20220518002318 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316563950 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Joanna Kyrie Gordon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881962413 PECOS PAC ID: 5395005508 Enrollment ID: I20180208001595 |
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