| Self And Family Behavioral Healthcare | |
|
7521 N Telegraph Rd Suite 1 Newport MI 48166-9398 | |
| (734) 586-0031 | |
| (734) 586-0032 |
| Full Name | Self And Family Behavioral Healthcare |
|---|---|
| Speciality | Psychologist |
| Location | 7521 N Telegraph Rd, Newport, Michigan |
| Authorized Official Name and Position | Ralph Lowe Hutchison (OWNER) |
| Authorized Official Contact | 7345860031 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Self And Family Behavioral Healthcare 7521 N Telegraph Rd Suite 1 Newport MI 48166-9398 Ph: (734) 586-0031 | Self And Family Behavioral Healthcare 7521 N Telegraph Rd Suite 1 Newport MI 48166-9398 Ph: (734) 586-0031 |
| NPI Number | 1497932800 |
|---|---|
| Provider Enumeration Date | 01/28/2008 |
| Last Update Date | 10/28/2008 |
| Medicare PECOS PAC ID | 6103984620 |
|---|---|
| Medicare Enrollment ID | O20081027000756 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497932800 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (Michigan) | Primary |
| Provider Name | Renee Harris |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043350895 PECOS PAC ID: 4688861198 Enrollment ID: I20101209001019 |
| Provider Name | Patricia Bowersox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336489251 PECOS PAC ID: 7214226596 Enrollment ID: I20160511000044 |
| Provider Name | Jean Ruth Miller-clarkson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942357934 PECOS PAC ID: 8921386707 Enrollment ID: I20161028001882 |
| Provider Name | Gwendolyn La Croix |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801343942 PECOS PAC ID: 9537443742 Enrollment ID: I20170308001087 |