| The Mindful Self, Llc | |
|
31201 Chicago Rd S Ste A201 Warren MI 48093-5552 | |
| (248) 543-0033 | |
| (248) 548-5309 |
| Full Name | The Mindful Self, Llc |
|---|---|
| Speciality | Counselor |
| Location | 31201 Chicago Rd S Ste A201, Warren, Michigan |
| Authorized Official Name and Position | Alisa M Hilewsky (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 2485430033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Mindful Self, Llc 31201 Chicago Rd S Ste A201 Warren MI 48093-5552 Ph: (248) 543-0033 | The Mindful Self, Llc 31201 Chicago Rd S Ste A201 Warren MI 48093-5552 Ph: (248) 543-0033 |
| NPI Number | 1477805463 |
|---|---|
| Provider Enumeration Date | 10/15/2012 |
| Last Update Date | 12/12/2024 |
| Certification Date | 12/12/2024 |
| Medicare PECOS PAC ID | 1456575711 |
|---|---|
| Medicare Enrollment ID | O20140609000185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477805463 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 6401011013 (Michigan) | Primary |
| 103T00000X | Psychologist | 6301024395 (Michigan) | Secondary |
| Provider Name | Lori A Ruppel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568575603 PECOS PAC ID: 8921004300 Enrollment ID: I20061006000383 |
| Provider Name | Alisa M Hilewsky |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407002447 PECOS PAC ID: 3072737337 Enrollment ID: I20161228000444 |
| Provider Name | Kelly R Karpowitsch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588204713 PECOS PAC ID: 5092141879 Enrollment ID: I20200214002234 |
| Provider Name | Dana Jeffery |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669846614 PECOS PAC ID: 1254748924 Enrollment ID: I20210324001806 |
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