| Intentional Life Therapy | |
|
10951 E Gypsy Lane Rd Bowling Green OH 43402-9565 | |
| (419) 913-4255 | |
| Not Available |
| Full Name | Intentional Life Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 10951 E Gypsy Lane Rd, Bowling Green, Ohio |
| Authorized Official Name and Position | Nicole Flores-mccune (OWNER/PROVIDER) |
| Authorized Official Contact | 4199134255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Life Therapy 9895 Huffman Rd Portage OH 43451-9739 Ph: (419) 913-4255 | Intentional Life Therapy 10951 E Gypsy Lane Rd Bowling Green OH 43402-9565 Ph: (419) 913-4255 |
| NPI Number | 1265180285 |
|---|---|
| Provider Enumeration Date | 03/17/2022 |
| Last Update Date | 04/25/2022 |
| Certification Date | 04/25/2022 |
| Medicare PECOS PAC ID | 0244627875 |
|---|---|
| Medicare Enrollment ID | O20220428000869 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265180285 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Nicole Flores-mccune |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639166051 PECOS PAC ID: 7012269715 Enrollment ID: I20181008002141 |
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