| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 205 N. East Ave, Jackson, Michigan |
| Authorized Official Name and Position | Mark Smith (SVP, CMO, CEO) |
| Authorized Official Contact | 5172056407 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 67000 Department 272801 Detroit MI 48267 Ph: (517) 841-7843 | 205 N. East Ave Jackson MI 49201 Ph: (517) 841-7843 |
| NPI Number | 1417494378 |
|---|---|
| Provider Enumeration Date | 01/30/2017 |
| Last Update Date | 03/06/2024 |
| Certification Date | 03/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417494378 | NPI | - | NPPES |
| 1326078866 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 1060000044 (Michigan) | Primary |
Alexis Ahlbaum Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 5633 Poplar Dr, Jackson, MI 49201 Phone: 517-270-1994 | |
Inner Guidance Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 608 W Michigan Ave, Jackson, MI 49201 Phone: 517-416-8878 Fax: 517-962-5316 | |
Center For Family Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 505 N Jackson St, Jackson, MI 49201 Phone: 517-748-5500 | |
Highfields Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1206 Clinton Rd, Jackson, MI 49202 Phone: 517-783-4250 | |