| Intentional Counseling Services | |
|
2142a Washtenaw Rd Ypsilanti MI 48197-1708 | |
| (734) 879-0162 | |
| (734) 879-0167 |
| Full Name | Intentional Counseling Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2142a Washtenaw Rd, Ypsilanti, Michigan |
| Authorized Official Name and Position | Stacey M Mack (LICENSED MASTER SOCIAL WORKER) |
| Authorized Official Contact | 7348790162 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Counseling Services 2142a Washtenaw Rd Ypsilanti MI 48197-1708 Ph: (734) 879-0162 | Intentional Counseling Services 2142a Washtenaw Rd Ypsilanti MI 48197-1708 Ph: (734) 879-0162 |
| NPI Number | 1427427814 |
|---|---|
| Provider Enumeration Date | 09/16/2015 |
| Last Update Date | 10/16/2024 |
| Certification Date | 10/14/2024 |
| Medicare PECOS PAC ID | 0244539245 |
|---|---|
| Medicare Enrollment ID | O20160426000606 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427427814 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Stacey M Mack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407017239 PECOS PAC ID: 5799910881 Enrollment ID: I20131025001146 |
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