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1021 Revere Dr Bowling Green OH 43402-1224 | |
| (419) 556-6807 | |
| (419) 643-9210 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1021 Revere Dr, Bowling Green, Ohio |
| Authorized Official Name and Position | Rania Haynes (OWNER) |
| Authorized Official Contact | 4195755830 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2111 E Wooster St Ste A1 Bowling Green OH 43402-9083 Ph: (419) 575-5830 | 1021 Revere Dr Bowling Green OH 43402-1224 Ph: (419) 556-6807 |
| NPI Number | 1295494706 |
|---|---|
| Provider Enumeration Date | 12/12/2021 |
| Last Update Date | 02/02/2024 |
| Certification Date | 02/02/2024 |
| Medicare PECOS PAC ID | 4587002001 |
|---|---|
| Medicare Enrollment ID | O20240403001910 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295494706 | NPI | - | NPPES |
| 0195981 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Rania Haynes |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417491713 PECOS PAC ID: 0840638367 Enrollment ID: I20240403002058 |
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