| Geodes, Anxiety And Trauma Clinic, Llc | |
|
1164 James Savage Rd Ste E Midland MI 48640-6843 | |
| (989) 513-5107 | |
| (855) 483-9638 |
| Full Name | Geodes, Anxiety And Trauma Clinic, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1164 James Savage Rd Ste E, Midland, Michigan |
| Authorized Official Name and Position | Nicole Lynette Bourlakas-maurer (OWNER, CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 9895135107 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Geodes, Anxiety And Trauma Clinic, Llc 1164 James Savage Rd Ste E Midland MI 48640-6843 Ph: (989) 513-5107 | Geodes, Anxiety And Trauma Clinic, Llc 1164 James Savage Rd Ste E Midland MI 48640-6843 Ph: (989) 513-5107 |
| NPI Number | 1861876468 |
|---|---|
| Provider Enumeration Date | 07/13/2015 |
| Last Update Date | 08/11/2015 |
| Medicare PECOS PAC ID | 8325450976 |
|---|---|
| Medicare Enrollment ID | O20201223002400 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861876468 | NPI | - | NPPES |
| 730195 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801085334 (Michigan) | Primary |
| Provider Name | Nicole Bourlakas-maurer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649418708 PECOS PAC ID: 3678629599 Enrollment ID: I20090917000698 |
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