| Trillium Counseling Services | |
|
3130 Logan Valley Rd Traverse City MI 49684-4772 | |
| (231) 409-8622 | |
| Not Available |
| Full Name | Trillium Counseling Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 3130 Logan Valley Rd, Traverse City, Michigan |
| Authorized Official Name and Position | Theresa A Evans (OWNER) |
| Authorized Official Contact | 2314098622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trillium Counseling Services 2506 Holland Cir Traverse City MI 49685-7410 Ph: (231) 409-8622 | Trillium Counseling Services 3130 Logan Valley Rd Traverse City MI 49684-4772 Ph: (231) 409-8622 |
| NPI Number | 1982194163 |
|---|---|
| Provider Enumeration Date | 05/14/2018 |
| Last Update Date | 09/26/2020 |
| Medicare PECOS PAC ID | 2365797313 |
|---|---|
| Medicare Enrollment ID | O20180615002291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982194163 | NPI | - | NPPES |
| 1972659845 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Theresa Anne Evans |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972659845 PECOS PAC ID: 9436106390 Enrollment ID: I20050401000867 |
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