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221 W Webster Ave Ste 514 Muskegon MI 49440-1294 | |
| (616) 843-0623 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 221 W Webster Ave Ste 514, Muskegon, Michigan |
| Authorized Official Name and Position | Anne Tyson (OWNER/CLINICIAN) |
| Authorized Official Contact | 6168430623 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1154 Cadillac Dr Muskegon MI 49445-1917 Ph: (616) 843-0623 | 221 W Webster Ave Ste 514 Muskegon MI 49440-1294 Ph: (616) 843-0623 |
| NPI Number | 1144703182 |
|---|---|
| Provider Enumeration Date | 09/14/2018 |
| Last Update Date | 01/17/2025 |
| Certification Date | 01/17/2025 |
| Medicare PECOS PAC ID | 0941544845 |
|---|---|
| Medicare Enrollment ID | O20181204001353 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144703182 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Anne Tyson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447472915 PECOS PAC ID: 0648280495 Enrollment ID: I20060425000312 |
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