| Revived Mind Counseling Services | |
|
2705 Tapestry Dr Okemos MI 48864-4611 | |
| (517) 930-9950 | |
| (517) 323-9531 |
| Full Name | Revived Mind Counseling Services |
|---|---|
| Speciality | Social Worker |
| Location | 2705 Tapestry Dr, Okemos, Michigan |
| Authorized Official Name and Position | Cathy Gallegos (CREDENTIALING MANAGER) |
| Authorized Official Contact | 5174832461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revived Mind Counseling Services 2705 Tapestry Dr Okemos MI 48864-4611 Ph: (517) 930-9950 | Revived Mind Counseling Services 2705 Tapestry Dr Okemos MI 48864-4611 Ph: (517) 930-9950 |
| NPI Number | 1083323570 |
|---|---|
| Provider Enumeration Date | 11/23/2022 |
| Last Update Date | 11/23/2022 |
| Certification Date | 11/23/2022 |
| Medicare PECOS PAC ID | 0840661351 |
|---|---|
| Medicare Enrollment ID | O20230120000188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083323570 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Jeffrey Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720435290 PECOS PAC ID: 8820469331 Enrollment ID: I20230120000376 |
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