| Children's Waiver Services | |
|
3111 Electric Ave Port Huron MI 48060-8127 | |
| (810) 985-8900 | |
| Not Available |
| Full Name | Children's Waiver Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3111 Electric Ave, Port Huron, Michigan |
| Authorized Official Name and Position | Debra B. Johnson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8109858900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Children's Waiver Services 3111 Electric Avenue Port Huron MI 48060-8127 Ph: (810) 985-8900 | Children's Waiver Services 3111 Electric Ave Port Huron MI 48060-8127 Ph: (810) 985-8900 |
| NPI Number | 1689783672 |
|---|---|
| Provider Enumeration Date | 08/30/2006 |
| Last Update Date | 08/07/2023 |
| Certification Date | 08/07/2023 |
| Medicare PECOS PAC ID | 7416861984 |
|---|---|
| Medicare Enrollment ID | O20031118000783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689783672 | NPI | - | NPPES |
| 4349015 | Medicaid | MI | |
| 1708164 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Andrea L Velez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225118318 PECOS PAC ID: 5597758946 Enrollment ID: I20040403000144 |
| Provider Name | Ann M Wrubel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841307204 PECOS PAC ID: 2062459332 Enrollment ID: I20050408000732 |
| Provider Name | Bradley J Mcdonald |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720195829 PECOS PAC ID: 6901802354 Enrollment ID: I20061009000264 |
| Provider Name | Thelma Y West |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477666006 PECOS PAC ID: 9436155892 Enrollment ID: I20061009000292 |
| Provider Name | Alexander T Samul |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619078987 PECOS PAC ID: 2264432103 Enrollment ID: I20061228000108 |
| Provider Name | Hope M Albers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659382125 PECOS PAC ID: 9931259736 Enrollment ID: I20090617000434 |
| Provider Name | Mary C Daniel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295968899 PECOS PAC ID: 3072659390 Enrollment ID: I20090930000082 |
| Provider Name | Melissa Ann Hunt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992987002 PECOS PAC ID: 9830235290 Enrollment ID: I20091015000346 |
| Provider Name | Cheri A Jessup |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184643777 PECOS PAC ID: 0345387916 Enrollment ID: I20091030000354 |
| Provider Name | Deborah L Kokoszka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023320413 PECOS PAC ID: 6800089186 Enrollment ID: I20101019000842 |
| Provider Name | Andrea Marie Zinzo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942312483 PECOS PAC ID: 0648454702 Enrollment ID: I20110414000096 |
| Provider Name | Cortney L Paddock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740425966 PECOS PAC ID: 6709056344 Enrollment ID: I20110908002237 |
| Provider Name | Ann Marie Daniels Hillman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447261821 PECOS PAC ID: 6002060563 Enrollment ID: I20130208000274 |
| Provider Name | Shannon E Mckeever |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629370101 PECOS PAC ID: 6103061007 Enrollment ID: I20130325000546 |
| Provider Name | Jessica A Schroeder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487928560 PECOS PAC ID: 6305168972 Enrollment ID: I20141210000539 |
| Provider Name | Jordyn Elizabeth Mccormick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245660430 PECOS PAC ID: 7214259639 Enrollment ID: I20141212002223 |
| Provider Name | Carolyn L Pringle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912308495 PECOS PAC ID: 5496029308 Enrollment ID: I20170915001751 |
| Provider Name | Amy C Oxie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043729742 PECOS PAC ID: 9537435870 Enrollment ID: I20171101000137 |
| Provider Name | Brian S Fanion |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013223775 PECOS PAC ID: 3971857335 Enrollment ID: I20181121001800 |
| Provider Name | Alexandra E Gabridge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073002424 PECOS PAC ID: 1153666219 Enrollment ID: I20181218000437 |
| Provider Name | Jeannie Jenuwine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851672646 PECOS PAC ID: 5395074900 Enrollment ID: I20190906002610 |
| Provider Name | Jon C Johnston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265591499 PECOS PAC ID: 2769814276 Enrollment ID: I20191120003050 |
| Provider Name | Joseph T Windhorst |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851764351 PECOS PAC ID: 9133551575 Enrollment ID: I20191122002276 |
| Provider Name | Timothy L Weaver |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730635731 PECOS PAC ID: 3779907753 Enrollment ID: I20200622001808 |
| Provider Name | Katherine L Jurn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134551021 PECOS PAC ID: 1658793872 Enrollment ID: I20200729000444 |
| Provider Name | Paula L Fine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932572476 PECOS PAC ID: 6709202286 Enrollment ID: I20200805001781 |
| Provider Name | Michael C Wesch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821422627 PECOS PAC ID: 5395153514 Enrollment ID: I20210427003051 |
| Provider Name | Sarah A Kruczynski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629631510 PECOS PAC ID: 6103234331 Enrollment ID: I20210427003128 |
| Provider Name | Nicolette M Mcgahey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821553280 PECOS PAC ID: 7315343597 Enrollment ID: I20210914001360 |
| Provider Name | Sara E Storm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366956765 PECOS PAC ID: 9830596816 Enrollment ID: I20210917000123 |
| Provider Name | Mary C Joye |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295491231 PECOS PAC ID: 4981094497 Enrollment ID: I20211123002832 |
| Provider Name | Sandra S Kammer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265548515 PECOS PAC ID: 9234043654 Enrollment ID: I20211201001550 |
| Provider Name | Kevin P Bautel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598428856 PECOS PAC ID: 1759771389 Enrollment ID: I20211214000865 |
| Provider Name | Linda J Butler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043220908 PECOS PAC ID: 8820489362 Enrollment ID: I20211217000262 |
| Provider Name | Jorden E Reid |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982128286 PECOS PAC ID: 9133510415 Enrollment ID: I20211221000817 |
| Provider Name | Kristen M Azzinaro |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013671056 PECOS PAC ID: 2567853849 Enrollment ID: I20211221000990 |
| Provider Name | Rebecca M Markel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760817738 PECOS PAC ID: 0941691257 Enrollment ID: I20211221001884 |
| Provider Name | Katrina J Parker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952701914 PECOS PAC ID: 0547651705 Enrollment ID: I20211222001482 |
| Provider Name | Glikeria N Hastings |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427464882 PECOS PAC ID: 5799176574 Enrollment ID: I20220105002296 |
| Provider Name | Gabriela E Rowinsky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861826513 PECOS PAC ID: 0941613673 Enrollment ID: I20220107000187 |
| Provider Name | Brooksley Brown Foster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790208445 PECOS PAC ID: 7416357975 Enrollment ID: I20220308001392 |
| Provider Name | Nathanael W Russell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093344681 PECOS PAC ID: 1254713886 Enrollment ID: I20220729000473 |
| Provider Name | Carla J Schott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265175582 PECOS PAC ID: 7618359175 Enrollment ID: I20220729001887 |
| Provider Name | David J Hogston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760805196 PECOS PAC ID: 8325423452 Enrollment ID: I20220909002583 |
| Provider Name | Brittany C Brothers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336618800 PECOS PAC ID: 4587049614 Enrollment ID: I20220909002667 |
| Provider Name | Alicia Burns |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326772914 PECOS PAC ID: 4587049622 Enrollment ID: I20220909002735 |
| Provider Name | Holly E Langmesser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912562844 PECOS PAC ID: 1658757257 Enrollment ID: I20221005002378 |
| Provider Name | Jadean I Lavery |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801490602 PECOS PAC ID: 8527439124 Enrollment ID: I20230118001704 |
| Provider Name | Danielle Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720695240 PECOS PAC ID: 2961873567 Enrollment ID: I20230118001849 |
| Provider Name | Cindy Sherwood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073527214 PECOS PAC ID: 4688662224 Enrollment ID: I20230123001372 |
| Provider Name | Camilla Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770184202 PECOS PAC ID: 4880069897 Enrollment ID: I20230405000585 |
| Provider Name | Dorothy Lmsw Molnar-macauley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861655102 PECOS PAC ID: 2365817384 Enrollment ID: I20230405000875 |
| Provider Name | Alana M Gottler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073961025 PECOS PAC ID: 6709251721 Enrollment ID: I20230405001024 |
| Provider Name | Ryan E Gladfelter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205189339 PECOS PAC ID: 1951776574 Enrollment ID: I20230413001671 |
| Provider Name | Anthony Theel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003225079 PECOS PAC ID: 6901261221 Enrollment ID: I20230420000773 |
| Provider Name | Leslie Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992714539 PECOS PAC ID: 7315302528 Enrollment ID: I20230421002437 |
| Provider Name | Suzzanne Sexton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144890179 PECOS PAC ID: 5991160210 Enrollment ID: I20230424000748 |
| Provider Name | Jennifer M Polio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891150850 PECOS PAC ID: 5890150627 Enrollment ID: I20230501002793 |
| Provider Name | Erin Attard |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1952011884 PECOS PAC ID: 8729444138 Enrollment ID: I20230509002325 |
| Provider Name | Shannon Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275296311 PECOS PAC ID: 1658761663 Enrollment ID: I20230617000085 |
| Provider Name | Jennifer M Ritchie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215585724 PECOS PAC ID: 0446619555 Enrollment ID: I20230707002406 |
| Provider Name | Danielle Klank |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588150767 PECOS PAC ID: 7517326531 Enrollment ID: I20230707002837 |
| Provider Name | Callie Gunn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003483215 PECOS PAC ID: 0042666554 Enrollment ID: I20231019001322 |
| Provider Name | Lauren Fanion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538790373 PECOS PAC ID: 3173970779 Enrollment ID: I20231102003818 |
| Provider Name | Annmarie Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942607601 PECOS PAC ID: 2062869456 Enrollment ID: I20231107000606 |
| Provider Name | Merindar Grant |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912195991 PECOS PAC ID: 4284087099 Enrollment ID: I20240129001934 |
| Provider Name | Janice Charzynski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1295748978 PECOS PAC ID: 1658724141 Enrollment ID: I20240131004257 |
| Provider Name | Sara Schoenberg |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609923051 PECOS PAC ID: 3476996372 Enrollment ID: I20240207003698 |
Anchor Counseling Services, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1423 Pine Grove Ave, Port Huron, MI 48060 Phone: 810-990-8720 | |
Dr. M. Rousseau, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 732 Holland Ave, Port Huron, MI 48060 Phone: 810-434-6280 | |
St. Clair County Sheriff Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1170 Michigan Rd, Port Huron, MI 48060 Phone: 810-966-1625 Fax: 810-966-4306 | |
St Clair County Community Mental Health Authority Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2415 24th St, Port Huron, MI 48060 Phone: 810-488-8840 Fax: 810-966-3393 | |
Changing Course Counseling, Plc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1423 Pine Grove Avenue, Port Huron, MI 48060 Phone: 810-357-9318 Fax: 810-479-9684 | |
St Clair County Community Mental Health Authority Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3111 Electric Ave, Port Huron, MI 48060 Phone: 810-985-8900 | |
Flint Odyssey House, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1431 Lapeer Ave, Port Huron, MI 48060 Phone: 810-238-7226 |