| Journey Within Llc | |
|
29623 Northwestern Hwy Southfield MI 48034-1076 | |
| (248) 225-8240 | |
| Not Available |
| Full Name | Journey Within Llc |
|---|---|
| Speciality | Social Worker |
| Location | 29623 Northwestern Hwy, Southfield, Michigan |
| Authorized Official Name and Position | Lori Ellen Gordon-michaeli (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2482258240 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Journey Within Llc 26342 Dundalk St Farmington Hills MI 48334-4812 Ph: (248) 225-8240 | Journey Within Llc 29623 Northwestern Hwy Southfield MI 48034-1076 Ph: (248) 225-8240 |
| NPI Number | 1720521958 |
|---|---|
| Provider Enumeration Date | 11/20/2016 |
| Last Update Date | 11/20/2016 |
| Medicare PECOS PAC ID | 9739469073 |
|---|---|
| Medicare Enrollment ID | O20161202002146 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720521958 | NPI | - | NPPES |
| 0963822 | Other | MI | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801095173 (Michigan) | Primary |
| Provider Name | Robert J Lagrou |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629279351 PECOS PAC ID: 3779645270 Enrollment ID: I20081217000396 |
| Provider Name | Deborah S Hochberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053551812 PECOS PAC ID: 6406902972 Enrollment ID: I20090924000520 |
| Provider Name | Lori E Gordon-michaeli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346616166 PECOS PAC ID: 7810277159 Enrollment ID: I20161202002186 |
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