| Nicole Moody Llc | |
|
541 E Grand River Ave Ste A1 East Lansing MI 48823-4445 | |
| (517) 515-4114 | |
| Not Available |
| Full Name | Nicole Moody Llc |
|---|---|
| Speciality | Social Worker |
| Location | 541 E Grand River Ave Ste A1, East Lansing, Michigan |
| Authorized Official Name and Position | Nicole L Moody (OWNER) |
| Authorized Official Contact | 5175154114 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Moody Llc 1144 Woodwind Trl Haslett MI 48840-8955 Ph: (517) 515-4114 | Nicole Moody Llc 541 E Grand River Ave Ste A1 East Lansing MI 48823-4445 Ph: (517) 515-4114 |
| NPI Number | 1295125144 |
|---|---|
| Provider Enumeration Date | 01/30/2015 |
| Last Update Date | 04/14/2022 |
| Certification Date | 04/14/2022 |
| Medicare PECOS PAC ID | 8921323742 |
|---|---|
| Medicare Enrollment ID | O20150218002001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295125144 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801090018 (Michigan) | Primary |
| Provider Name | Nicole L Moody |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104244391 PECOS PAC ID: 3274766738 Enrollment ID: I20140507001790 |
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