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8080 Moorsbridge Rd Ste 203 Portage MI 49024-4422 | |
| (269) 371-3700 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 8080 Moorsbridge Rd Ste 203, Portage, Michigan |
| Authorized Official Name and Position | Garrett Brookmyer (OWNER) |
| Authorized Official Contact | 2693713700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8080 Moorsbridge Rd Ste 203 Portage MI 49024-4422 Ph: (269) 371-3700 | 8080 Moorsbridge Rd Ste 203 Portage MI 49024-4422 Ph: (269) 371-3700 |
| NPI Number | 1932757937 |
|---|---|
| Provider Enumeration Date | 09/03/2019 |
| Last Update Date | 02/10/2023 |
| Certification Date | 02/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932757937 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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