| Trio Wellspace, Llc | |
|
486 Century Ln Holland MI 49423-4295 | |
| (616) 886-1265 | |
| Not Available |
| Full Name | Trio Wellspace, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 486 Century Ln, Holland, Michigan |
| Authorized Official Name and Position | Molly Henson-boone (CO-OWNER) |
| Authorized Official Contact | 6162982731 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trio Wellspace, Llc 486 Century Ln Holland MI 49423-4295 Ph: (616) 298-2731 | Trio Wellspace, Llc 486 Century Ln Holland MI 49423-4295 Ph: (616) 886-1265 |
| NPI Number | 1831859826 |
|---|---|
| Provider Enumeration Date | 12/18/2021 |
| Last Update Date | 07/21/2022 |
| Certification Date | 07/14/2022 |
| Medicare PECOS PAC ID | 5092197699 |
|---|---|
| Medicare Enrollment ID | O20220728002897 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831859826 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Molly B Henson Boone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588064372 PECOS PAC ID: 2860702750 Enrollment ID: I20151104003059 |
| Provider Name | Amy Louise Perricone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194463745 PECOS PAC ID: 3274994140 Enrollment ID: I20230726000249 |
| Provider Name | Michelle Mcdonald |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558837484 PECOS PAC ID: 8224480439 Enrollment ID: I20240123002839 |
| Provider Name | Gayle Shumaker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104938240 PECOS PAC ID: 9537541131 Enrollment ID: I20240130002266 |
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