| Optimum Balance | |
|
1537 N. Leroy Street Suite D Fenton MI 48430 | |
| (810) 771-8969 | |
| Not Available |
| Full Name | Optimum Balance |
|---|---|
| Speciality | Clinic/Center |
| Location | 1537 N. Leroy Street, Fenton, Michigan |
| Authorized Official Name and Position | Karl Stanley Gill (OWNER) |
| Authorized Official Contact | 8107718969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimum Balance 1537 N Leroy St Ste D Fenton MI 48430-2795 Ph: (810) 771-8969 | Optimum Balance 1537 N. Leroy Street Suite D Fenton MI 48430 Ph: (810) 771-8969 |
| NPI Number | 1245767888 |
|---|---|
| Provider Enumeration Date | 05/14/2017 |
| Last Update Date | 09/17/2020 |
| Certification Date | 09/17/2020 |
| Medicare PECOS PAC ID | 9739418351 |
|---|---|
| Medicare Enrollment ID | O20190906003138 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245767888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 6401013238 (Michigan) | Primary |
| Provider Name | Joseph Dragun |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093789448 PECOS PAC ID: 1355321845 Enrollment ID: I20040724000029 |
| Provider Name | Lawrence R Koper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134482573 PECOS PAC ID: 8022251628 Enrollment ID: I20130829000684 |
| Provider Name | Joshua Fortney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073854576 PECOS PAC ID: 7719382795 Enrollment ID: I20211013002040 |
| Provider Name | Kimberly Marie Sanderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659044683 PECOS PAC ID: 9133584907 Enrollment ID: I20230501000433 |
| Provider Name | Teresa Traks-garrison |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1659972297 PECOS PAC ID: 2567815558 Enrollment ID: I20240125003496 |
| Provider Name | Rachel Mroz |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1750896536 PECOS PAC ID: 9032557368 Enrollment ID: I20240405002055 |
| Provider Name | Karl Stanley Gill |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447503651 PECOS PAC ID: 0648509265 Enrollment ID: I20240417002890 |
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