| Innovations By Gomes Incorporated | |
|
7640 Dixie Hwy Ste 155 Clarkston MI 48346-2095 | |
| (248) 318-7051 | |
| Not Available |
| Full Name | Innovations By Gomes Incorporated |
|---|---|
| Speciality | Counselor |
| Location | 7640 Dixie Hwy Ste 155, Clarkston, Michigan |
| Authorized Official Name and Position | Lauren Ruben (CLINIC DIRECTOR) |
| Authorized Official Contact | 2483187051 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovations By Gomes Incorporated 7640 Dixie Hwy Ste 155 Clarkston MI 48346-2095 Ph: (248) 318-7051 | Innovations By Gomes Incorporated 7640 Dixie Hwy Ste 155 Clarkston MI 48346-2095 Ph: (248) 318-7051 |
| NPI Number | 1881389906 |
|---|---|
| Provider Enumeration Date | 04/05/2023 |
| Last Update Date | 04/05/2023 |
| Certification Date | 04/05/2023 |
| Medicare PECOS PAC ID | 0446613665 |
|---|---|
| Medicare Enrollment ID | O20230905003299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881389906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jessica Danielle Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174186159 PECOS PAC ID: 1658607221 Enrollment ID: I20190719003083 |
| Provider Name | Stefanie Ann Sabin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629320684 PECOS PAC ID: 1052640133 Enrollment ID: I20190916001437 |
| Provider Name | Tanya Roe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164852430 PECOS PAC ID: 6901279611 Enrollment ID: I20230228001844 |
| Provider Name | Raeleen Nicole Davis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730555459 PECOS PAC ID: 7113377284 Enrollment ID: I20240102002436 |
| Provider Name | Lauren Rae Ruben |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235500331 PECOS PAC ID: 9436512654 Enrollment ID: I20240102002822 |
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