| Lindsay P. South, Ma Pllc | |
|
1591 W Centre Ave Suite 103 Portage MI 49024-6314 | |
| (269) 323-2553 | |
| Not Available |
| Full Name | Lindsay P. South, Ma Pllc |
|---|---|
| Speciality | Counselor |
| Location | 1591 W Centre Ave, Portage, Michigan |
| Authorized Official Name and Position | Connie E. Webb (OFFICE MANAGER) |
| Authorized Official Contact | 2693033835 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lindsay P. South, Ma Pllc 1591 W. Centre Avenue Suite 103 Portage MI 49024-5342 Ph: (269) 323-2553 | Lindsay P. South, Ma Pllc 1591 W Centre Ave Suite 103 Portage MI 49024-6314 Ph: (269) 323-2553 |
| NPI Number | 1346600947 |
|---|---|
| Provider Enumeration Date | 02/25/2016 |
| Last Update Date | 03/08/2016 |
| Medicare PECOS PAC ID | 7315389582 |
|---|---|
| Medicare Enrollment ID | O20240521000521 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346600947 | NPI | - | NPPES |
| 1942396205 | Other | MI | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 6401005843 (Michigan) | Primary |
| Provider Name | Lindsay South |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942396205 PECOS PAC ID: 6800238973 Enrollment ID: I20240522000491 |
| Provider Name | Shannon E. Aardema |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1093070153 PECOS PAC ID: 0840732665 Enrollment ID: I20240607003469 |
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