| Michiana Counseling Group, Llc | |
|
56218 Parkway Ave Suite B Elkhart IN 46516-9326 | |
| (574) 293-0005 | |
| (574) 293-0019 |
| Full Name | Michiana Counseling Group, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 56218 Parkway Ave, Elkhart, Indiana |
| Authorized Official Name and Position | Jessica L. Lala (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 5743447941 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michiana Counseling Group, Llc 56218 Parkway Ave Suite B Elkhart IN 46516-9326 Ph: (574) 293-0005 | Michiana Counseling Group, Llc 56218 Parkway Ave Suite B Elkhart IN 46516-9326 Ph: (574) 293-0005 |
| NPI Number | 1396180659 |
|---|---|
| Provider Enumeration Date | 04/30/2013 |
| Last Update Date | 04/30/2013 |
| Medicare PECOS PAC ID | 0941442784 |
|---|---|
| Medicare Enrollment ID | O20130807000902 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396180659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 34003589A (Indiana) | Primary |
| Provider Name | Joanna B Woolace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558705368 PECOS PAC ID: 3577705318 Enrollment ID: I20130807000934 |
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