| |
1101 Military St Port Huron MI 48060-5418 | |
(810) 984-5575 | |
(810) 984-6433 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1101 Military St, Port Huron, Michigan |
Authorized Official Name and Position | Laurie L Goetze (DIRECTOR) |
Authorized Official Contact | 8109845575 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1101 Military St Port Huron MI 48060-5418 Ph: (810) 984-5575 | 1101 Military St Port Huron MI 48060-5418 Ph: (810) 984-5575 |
NPI Number | 1033372818 |
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Provider Enumeration Date | 07/02/2008 |
Last Update Date | 08/30/2022 |
Medicare PECOS PAC ID | 7810140043 |
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Medicare Enrollment ID | O20130118000437 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033372818 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Christina A Howard |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1366452021 PECOS PAC ID: 0143407833 Enrollment ID: I20110606000738 |
Provider Name | Laurie L Goetze |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1750481289 PECOS PAC ID: 5092975433 Enrollment ID: I20120322000372 |
Provider Name | Ryan W Smith |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1629185681 PECOS PAC ID: 0042468761 Enrollment ID: I20120920000700 |
Provider Name | Jonathan P Howard |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1467616789 PECOS PAC ID: 1658524749 Enrollment ID: I20130124000264 |
Provider Name | Andrea L Dalman |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1154601714 PECOS PAC ID: 5294045241 Enrollment ID: I20151104000858 |
Provider Name | Travis Wolff |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1881078178 PECOS PAC ID: 4082013842 Enrollment ID: I20210527000397 |
Provider Name | Renee Morris |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1407224413 PECOS PAC ID: 5698174456 Enrollment ID: I20210527000486 |
Provider Name | Shawne Jowett |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1790417061 PECOS PAC ID: 5890144349 Enrollment ID: I20231211000231 |
Provider Name | Barbara Stocker |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1265565501 PECOS PAC ID: 4183073224 Enrollment ID: I20231214000330 |
Provider Name | Janet Smith |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1922702687 PECOS PAC ID: 4587014154 Enrollment ID: I20231221003355 |
Provider Name | Shasta Belt |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1699345801 PECOS PAC ID: 9739624958 Enrollment ID: I20240712000115 |
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