| Mindful Living Pllc | |
|
810 E Grand River Ave Ste 101 Brighton MI 48116-1878 | |
| (810) 588-4236 | |
| (810) 588-4247 |
| Full Name | Mindful Living Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 810 E Grand River Ave Ste 101, Brighton, Michigan |
| Authorized Official Name and Position | Debbie Koeltzow (CLINIC DIRECTOR) |
| Authorized Official Contact | 7346578059 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Living Pllc 2460 Carriage Way Ypsilanti MI 48197-7423 Ph: (734) 657-8059 | Mindful Living Pllc 810 E Grand River Ave Ste 101 Brighton MI 48116-1878 Ph: (810) 588-4236 |
| NPI Number | 1013145879 |
|---|---|
| Provider Enumeration Date | 06/30/2009 |
| Last Update Date | 06/30/2009 |
| Medicare PECOS PAC ID | 6709914690 |
|---|---|
| Medicare Enrollment ID | O20100513000965 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013145879 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 6301011430 (Michigan) | Primary |
| Provider Name | Debbie A Koeltzow |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902004070 PECOS PAC ID: 7416085311 Enrollment ID: I20100513001018 |
| Provider Name | Ilene Lee Beninson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548664683 PECOS PAC ID: 4981826831 Enrollment ID: I20141110002198 |
| Provider Name | Jacqueline Konley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093247702 PECOS PAC ID: 9638526213 Enrollment ID: I20231104000220 |
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