| Fresh Aire Samaritan Counseling Center | |
|
315 W Larkin St Midland MI 48640-5152 | |
| (989) 835-7511 | |
| Not Available |
| Full Name | Fresh Aire Samaritan Counseling Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 315 W Larkin St, Midland, Michigan |
| Authorized Official Name and Position | Lisa M Mcilvenna (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9898357511 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fresh Aire Samaritan Counseling Center 315 W Larkin St Midland MI 48640-5152 Ph: (989) 835-7511 | Fresh Aire Samaritan Counseling Center 315 W Larkin St Midland MI 48640-5152 Ph: (989) 835-7511 |
| NPI Number | 1235491556 |
|---|---|
| Provider Enumeration Date | 06/12/2012 |
| Last Update Date | 06/12/2012 |
| Medicare PECOS PAC ID | 4183987167 |
|---|---|
| Medicare Enrollment ID | O20180405000938 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235491556 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 6401010105 (Michigan) | Primary |
| Provider Name | Colleen O Gorman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548644453 PECOS PAC ID: 3274896048 Enrollment ID: I20180409000411 |
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