| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 8814 Cedar Lane, Clarkston, Michigan |
| Authorized Official Name and Position | Karen Ann Bashawaty (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 2485574006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
8814 Cedar Lane Clarkston MI 48348 Ph: (248) 557-4006 | 8814 Cedar Lane Clarkston MI 48348 Ph: (248) 557-4006 |
| NPI Number | 1720730674 |
|---|---|
| Provider Enumeration Date | 01/21/2022 |
| Last Update Date | 07/11/2024 |
| Certification Date | 12/27/2023 |
| Medicare PECOS PAC ID | 8022549955 |
|---|---|
| Medicare Enrollment ID | O20241003000294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720730674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Karen Bashawaty |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881739605 PECOS PAC ID: 8426217944 Enrollment ID: I20240801000362 |
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