| Aqueous Transitions PLLC | |
|
28345 Beck Rd Ste 101 Wixom MI 48393-4733 | |
| (248) 716-0580 | |
| Not Available |
| Full Name | Aqueous Transitions PLLC |
|---|---|
| Speciality | Counselor |
| Location | 28345 Beck Rd Ste 101, Wixom, Michigan |
| Authorized Official Name and Position | Jennifer Anderson (OWNER) |
| Authorized Official Contact | 2487160580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aqueous Transitions PLLC 28345 Beck Rd Ste 101 Wixom MI 48393-4733 Ph: (248) 716-0580 | Aqueous Transitions PLLC 28345 Beck Rd Ste 101 Wixom MI 48393-4733 Ph: (248) 716-0580 |
| NPI Number | 1316834856 |
|---|---|
| Provider Enumeration Date | 06/18/2025 |
| Last Update Date | 06/18/2025 |
| Certification Date | 06/18/2025 |
| Medicare PECOS PAC ID | 8921597667 |
|---|---|
| Medicare Enrollment ID | O20251031001191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316834856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (NU) | Primary |
| Provider Name | Jennifer Anderson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184386708 PECOS PAC ID: 3971947243 Enrollment ID: I20240215000772 |
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