| Theresa Windham Lmsw Llc | |
|
569 Wildwood Ave Unit 1 Jackson MI 49201-1048 | |
| (517) 798-5555 | |
| Not Available |
| Full Name | Theresa Windham Lmsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 569 Wildwood Ave Unit 1, Jackson, Michigan |
| Authorized Official Name and Position | Marybeth Houpt (CREDENTIALING) |
| Authorized Official Contact | 5176769797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theresa Windham Lmsw Llc Po Box 10 Mason MI 48854-0010 Ph: () - | Theresa Windham Lmsw Llc 569 Wildwood Ave Unit 1 Jackson MI 49201-1048 Ph: (517) 798-5555 |
| NPI Number | 1134769276 |
|---|---|
| Provider Enumeration Date | 01/07/2020 |
| Last Update Date | 04/03/2023 |
| Certification Date | 04/03/2023 |
| Medicare PECOS PAC ID | 0244666360 |
|---|---|
| Medicare Enrollment ID | O20200210001920 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134769276 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Theresa Lmsw Windham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841657772 PECOS PAC ID: 8921371055 Enrollment ID: I20170912000445 |
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