| Sacred Healing Therapeutic Services Llc | |
|
6144 Devon St Portage MI 49024-2648 | |
| (734) 709-2096 | |
| Not Available |
| Full Name | Sacred Healing Therapeutic Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 6144 Devon St, Portage, Michigan |
| Authorized Official Name and Position | Mary Beth 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 |
|---|---|
| Sacred Healing Therapeutic Services Llc Po Box 10 Mason MI 48854-0010 Ph: () - | Sacred Healing Therapeutic Services Llc 6144 Devon St Portage MI 49024-2648 Ph: (734) 709-2096 |
| NPI Number | 1952806556 |
|---|---|
| Provider Enumeration Date | 03/26/2018 |
| Last Update Date | 02/03/2022 |
| Certification Date | 02/03/2022 |
| Medicare PECOS PAC ID | 5890059737 |
|---|---|
| Medicare Enrollment ID | O20180501002227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952806556 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | 6801075829 (Michigan) | Secondary |
| Provider Name | Tiffany L Mazurek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780008284 PECOS PAC ID: 7416211131 Enrollment ID: I20180507002350 |
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