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6070 Newport Rd Portage MI 49002-9234 | |
| (269) 409-3000 | |
| (269) 366-4004 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 6070 Newport Rd, Portage, Michigan |
| Authorized Official Name and Position | Kathy Piecuch (OWNER/THERAPIST) |
| Authorized Official Contact | 2693033289 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6070 Newport Rd Portage MI 49002-9234 Ph: (269) 409-3000 | 6070 Newport Rd Portage MI 49002-9234 Ph: (269) 409-3000 |
| NPI Number | 1659737666 |
|---|---|
| Provider Enumeration Date | 01/06/2016 |
| Last Update Date | 10/23/2024 |
| Certification Date | 10/23/2024 |
| Medicare PECOS PAC ID | 6002359569 |
|---|---|
| Medicare Enrollment ID | O20240625002144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659737666 | NPI | - | NPPES |
| Provider Name | Justice Spearritt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811478639 PECOS PAC ID: 8921408212 Enrollment ID: I20210608001442 |
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