| Kanaan Therapy And Behavioral Health Services, Llc | |
|
816 East Michigan Avenue Suite 103 Paw Paw MI 49079-9510 | |
| (269) 815-8168 | |
| Not Available |
| Full Name | Kanaan Therapy And Behavioral Health Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 816 East Michigan Avenue, Paw Paw, Michigan |
| Authorized Official Name and Position | Timothy Adli Kanaan (OWNER/PARTNER) |
| Authorized Official Contact | 2698158168 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kanaan Therapy And Behavioral Health Services, Llc 816 East Michigan Avenue Suite 103 Paw Paw MI 49079-9510 Ph: (269) 815-8168 | Kanaan Therapy And Behavioral Health Services, Llc 816 East Michigan Avenue Suite 103 Paw Paw MI 49079-9510 Ph: (269) 815-8168 |
| NPI Number | 1174051619 |
|---|---|
| Provider Enumeration Date | 05/29/2017 |
| Last Update Date | 02/20/2020 |
| Certification Date | 02/20/2020 |
| Medicare PECOS PAC ID | 6709122930 |
|---|---|
| Medicare Enrollment ID | O20190109002213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174051619 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 6401012892 (Michigan) | Primary |
| 1041C0700X | Social Worker - Clinical | 6801092614 (Michigan) | Secondary |
| Provider Name | Paula R Kanaan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558608729 PECOS PAC ID: 8325278104 Enrollment ID: I20140221000952 |
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