| Thea Woodnorth Counseling Services Llc | |
|
2040 Raybrook St Se Ste 301d Grand Rapids MI 49546-7775 | |
| (616) 304-0274 | |
| (517) 323-9531 |
| Full Name | Thea Woodnorth Counseling Services Llc |
|---|---|
| Speciality | Counselor |
| Location | 2040 Raybrook St Se Ste 301d, Grand Rapids, Michigan |
| Authorized Official Name and Position | Cathy Gallegos (CREDENTIALING MANAGER) |
| Authorized Official Contact | 5174832461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thea Woodnorth Counseling Services Llc 1539 Blythe Ct Nw Grand Rapids MI 49504-2530 Ph: () - | Thea Woodnorth Counseling Services Llc 2040 Raybrook St Se Ste 301d Grand Rapids MI 49546-7775 Ph: (616) 304-0274 |
| NPI Number | 1144989146 |
|---|---|
| Provider Enumeration Date | 12/17/2021 |
| Last Update Date | 11/25/2024 |
| Certification Date | 11/25/2024 |
| Medicare PECOS PAC ID | 9335674787 |
|---|---|
| Medicare Enrollment ID | O20241122000940 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144989146 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Thea Woodnorth |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558929885 PECOS PAC ID: 3971038027 Enrollment ID: I20241126001531 |
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