| Great Lakes Comprehensive Psychological Services | |
|
1200 N West Ave Ste 812 Jackson MI 49202-2180 | |
| (517) 783-4418 | |
| (517) 783-4504 |
| Full Name | Great Lakes Comprehensive Psychological Services |
|---|---|
| Speciality | Social Worker |
| Location | 1200 N West Ave Ste 812, Jackson, Michigan |
| Authorized Official Name and Position | Marhta Catherine Kelley (OWNER) |
| Authorized Official Contact | 5177834418 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Comprehensive Psychological Services 1200 N West Ave Ste 812 Jackson MI 49202-2180 Ph: (517) 783-4418 | Great Lakes Comprehensive Psychological Services 1200 N West Ave Ste 812 Jackson MI 49202-2180 Ph: (517) 783-4418 |
| NPI Number | 1992336457 |
|---|---|
| Provider Enumeration Date | 02/03/2020 |
| Last Update Date | 02/03/2020 |
| Certification Date | 02/03/2020 |
| Medicare PECOS PAC ID | 1153759998 |
|---|---|
| Medicare Enrollment ID | O20200310001712 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992336457 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | John S Hand |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710042916 PECOS PAC ID: 5991975211 Enrollment ID: I20110824000512 |
| Provider Name | Martha C Kelley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972649572 PECOS PAC ID: 9638349962 Enrollment ID: I20110824000563 |
| Provider Name | Carol A Heckaman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891160511 PECOS PAC ID: 8729383484 Enrollment ID: I20160218001024 |
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