Resilience Therapy Llc | |
2335 Burton St Se Ste 210 Grand Rapids MI 49506-4669 | |
(616) 236-3600 | |
(616) 369-1449 |
Full Name | Resilience Therapy Llc |
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Speciality | Social Worker |
Location | 2335 Burton St Se Ste 210, Grand Rapids, Michigan |
Authorized Official Name and Position | Marybeth Houpt (CREDENTIALING) |
Authorized Official Contact | 5176769788 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Resilience Therapy Llc Po Box 10 Mason MI 48854-0010 Ph: (517) 676-9788 | Resilience Therapy Llc 2335 Burton St Se Ste 210 Grand Rapids MI 49506-4669 Ph: (616) 236-3600 |
NPI Number | 1184225575 |
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Provider Enumeration Date | 11/03/2020 |
Last Update Date | 08/18/2022 |
Certification Date | 08/18/2022 |
Medicare PECOS PAC ID | 7113337809 |
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Medicare Enrollment ID | O20201109001849 |
Identifier | Type | State | Issuer |
---|---|---|---|
1184225575 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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104100000X | Social Worker | (* (Not Available)) | Primary |
Provider Name | Ebony Shianne Crane |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1083199467 PECOS PAC ID: 8022428713 Enrollment ID: I20201109001919 |
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