| Great Lakes Psychological Associates Pllc | |
|
400 S University Ave Mt Pleasant MI 48858-3170 | |
| (989) 317-3188 | |
| (989) 202-1888 |
| Full Name | Great Lakes Psychological Associates Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 400 S University Ave, Mt Pleasant, Michigan |
| Authorized Official Name and Position | Jeremy Adam Moeggenberg (OWNER) |
| Authorized Official Contact | 9893173188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Psychological Associates Pllc 400 S University Ave Mt Pleasant MI 48858-3170 Ph: (989) 317-3188 | Great Lakes Psychological Associates Pllc 400 S University Ave Mt Pleasant MI 48858-3170 Ph: (989) 317-3188 |
| NPI Number | 1205205747 |
|---|---|
| Provider Enumeration Date | 09/15/2015 |
| Last Update Date | 01/04/2019 |
| Medicare PECOS PAC ID | 4284944364 |
|---|---|
| Medicare Enrollment ID | O20151102000530 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205205747 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301014926 (Michigan) | Primary |
| Provider Name | Jeremy A Moeggenberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558593707 PECOS PAC ID: 5799095881 Enrollment ID: I20151102000751 |
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