| Sacred Oak Counseling, P.l.l.c. | |
|
21610 E 11 Mile Rd Saint Clair Shores MI 48081-1671 | |
| (586) 913-1530 | |
| Not Available |
| Full Name | Sacred Oak Counseling, P.l.l.c. |
|---|---|
| Speciality | Social Worker |
| Location | 21610 E 11 Mile Rd, Saint Clair Shores, Michigan |
| Authorized Official Name and Position | Carissa Gluth (FOUNDER / THERAPIST) |
| Authorized Official Contact | 5869131530 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Oak Counseling, P.l.l.c. 21610 E 11 Mile Rd Saint Clair Shores MI 48081-1671 Ph: (586) 913-1530 | Sacred Oak Counseling, P.l.l.c. 21610 E 11 Mile Rd Saint Clair Shores MI 48081-1671 Ph: (586) 913-1530 |
| NPI Number | 1881177236 |
|---|---|
| Provider Enumeration Date | 09/12/2018 |
| Last Update Date | 09/07/2023 |
| Certification Date | 09/07/2023 |
| Medicare PECOS PAC ID | 9032462387 |
|---|---|
| Medicare Enrollment ID | O20181102001290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881177236 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Carissa Gluth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588912406 PECOS PAC ID: 7315245172 Enrollment ID: I20160411001701 |
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