| Blue Lake Counseling Pllc | |
|
2079 Edward Ln E Kimball MI 48074-1925 | |
| (810) 666-5033 | |
| Not Available |
| Full Name | Blue Lake Counseling Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 2079 Edward Ln E, Kimball, Michigan |
| Authorized Official Name and Position | Heather Renee Miller (OWNER) |
| Authorized Official Contact | 8106665033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Lake Counseling Pllc 2079 Edward Ln E Kimball MI 48074-1925 Ph: (810) 666-5033 | Blue Lake Counseling Pllc 2079 Edward Ln E Kimball MI 48074-1925 Ph: (810) 666-5033 |
| NPI Number | 1346853108 |
|---|---|
| Provider Enumeration Date | 08/31/2020 |
| Last Update Date | 08/31/2020 |
| Certification Date | 08/31/2020 |
| Medicare PECOS PAC ID | 6305265646 |
|---|---|
| Medicare Enrollment ID | O20201006001145 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346853108 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Heather Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164790747 PECOS PAC ID: 4688841844 Enrollment ID: I20120111000862 |
Nancy Rietdorf Phd Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2837 Stable Dr, Suite B, Kimball, MI 48074 Phone: 810-985-8000 Fax: 810-985-8044 |