| Lake House Counseling Pllc | |
|
1510 Morton Ave Saint Joseph MI 49085-1524 | |
| (517) 862-9389 | |
| Not Available |
| Full Name | Lake House Counseling Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1510 Morton Ave, Saint Joseph, Michigan |
| Authorized Official Name and Position | Mary Beth Houpt (CREDENTIALING) |
| Authorized Official Contact | 5176769797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake House Counseling Pllc Po Box 10 Mason MI 48854-0010 Ph: (517) 676-9788 | Lake House Counseling Pllc 1510 Morton Ave Saint Joseph MI 49085-1524 Ph: (517) 862-9389 |
| NPI Number | 1053880146 |
|---|---|
| Provider Enumeration Date | 11/19/2018 |
| Last Update Date | 05/08/2023 |
| Certification Date | 05/08/2023 |
| Medicare PECOS PAC ID | 6204171457 |
|---|---|
| Medicare Enrollment ID | O20181217003063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053880146 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Kristi A Daane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235142811 PECOS PAC ID: 3678855640 Enrollment ID: I20170126002666 |
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