| Dw Raising Plc | |
|
17172 Burkshire Dr Grand Haven MI 49417-8838 | |
| (602) 290-0672 | |
| Not Available |
| Full Name | Dw Raising Plc |
|---|---|
| Speciality | Psychologist |
| Location | 17172 Burkshire Dr, Grand Haven, Michigan |
| Authorized Official Name and Position | Marta Desoto (OWNER) |
| Authorized Official Contact | 6022900672 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dw Raising Plc 17172 Burkshire Dr Grand Haven MI 49417-8838 Ph: (602) 290-0672 | Dw Raising Plc 17172 Burkshire Dr Grand Haven MI 49417-8838 Ph: (602) 290-0672 |
| NPI Number | 1770358228 |
|---|---|
| Provider Enumeration Date | 11/15/2023 |
| Last Update Date | 11/15/2023 |
| Certification Date | 11/15/2023 |
| Medicare PECOS PAC ID | 1951750132 |
|---|---|
| Medicare Enrollment ID | O20231213002152 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770358228 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Marta Desoto |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598983686 PECOS PAC ID: 3779654926 Enrollment ID: I20170907000657 |
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