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 |
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Provider Enumeration Date | 11/15/2023 |
Last Update Date | 11/15/2023 |
Certification Date | 11/15/2023 |
Medicare PECOS PAC ID | 1951750132 |
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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 |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1598983686 PECOS PAC ID: 3779654926 Enrollment ID: I20170907000657 |
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