Rochester Evidence-based Psychotherapy Clinic, Pllc | |
414 S Main St Suite 201 Rochester MI 48307 | |
(248) 568-5180 | |
(248) 429-2132 |
Full Name | Rochester Evidence-based Psychotherapy Clinic, Pllc |
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Speciality | Counselor |
Location | 414 S Main St, Rochester, Michigan |
Authorized Official Name and Position | Adam G. Hamilton (OWNER) |
Authorized Official Contact | 2485685180 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Rochester Evidence-based Psychotherapy Clinic, Pllc 414 S Main St Suite 201 Rochester MI 48307-2068 Ph: (248) 568-5180 | Rochester Evidence-based Psychotherapy Clinic, Pllc 414 S Main St Suite 201 Rochester MI 48307 Ph: (248) 568-5180 |
NPI Number | 1326580432 |
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Provider Enumeration Date | 11/07/2016 |
Last Update Date | 06/22/2018 |
Medicare PECOS PAC ID | 5496007254 |
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Medicare Enrollment ID | O20181008000217 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326580432 | NPI | - | NPPES |
1417247768 | Other | INDIVIDUAL NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 6401011306 (Michigan) | Primary |
106H00000X | Marriage & Family Therapist | 4101006671 (Michigan) | Secondary |
Provider Name | Mark A Mitchell |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1053364307 PECOS PAC ID: 3678585346 Enrollment ID: I20060620000283 |
Provider Name | Linda A Burton |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1568748267 PECOS PAC ID: 5597984294 Enrollment ID: I20140911000648 |
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