| Gemswithin | |
|
756 N Madison St Crown Point IN 46307-8210 | |
| (219) 779-0509 | |
| (219) 738-6714 |
| Full Name | Gemswithin |
|---|---|
| Speciality | Counselor |
| Location | 756 N Madison St, Crown Point, Indiana |
| Authorized Official Name and Position | Lynn Mcdonald (CREDENTIALING) |
| Authorized Official Contact | 2197691670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gemswithin 756 N Madison St Crown Point IN 46307-8210 Ph: (219) 779-0509 | Gemswithin 756 N Madison St Crown Point IN 46307-8210 Ph: (219) 779-0509 |
| NPI Number | 1043804750 |
|---|---|
| Provider Enumeration Date | 02/23/2021 |
| Last Update Date | 02/23/2021 |
| Certification Date | 02/23/2021 |
| Medicare PECOS PAC ID | 5890100986 |
|---|---|
| Medicare Enrollment ID | O20210223002951 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043804750 | NPI | - | NPPES |
| 300046922 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Claude Ann Poupolos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063828879 PECOS PAC ID: 6507133857 Enrollment ID: I20170517001714 |
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