| Jeremiah Tree Ccs | |
|
501 Gloucester St Ste 117 Brunswick GA 31520-7030 | |
| (912) 244-9919 | |
| Not Available |
| Full Name | Jeremiah Tree Ccs |
|---|---|
| Speciality | Counselor |
| Location | 501 Gloucester St Ste 117, Brunswick, Georgia |
| Authorized Official Name and Position | Leeann Gumulauskas (LPC/OWNER) |
| Authorized Official Contact | 9122449919 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeremiah Tree Ccs 501 Gloucester St Ste 117 Brunswick GA 31520-7030 Ph: (912) 244-9919 | Jeremiah Tree Ccs 501 Gloucester St Ste 117 Brunswick GA 31520-7030 Ph: (912) 244-9919 |
| NPI Number | 1548099682 |
|---|---|
| Provider Enumeration Date | 07/29/2024 |
| Last Update Date | 07/29/2024 |
| Certification Date | 07/29/2024 |
| Medicare PECOS PAC ID | 4183135155 |
|---|---|
| Medicare Enrollment ID | O20250617000710 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548099682 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | () | Primary |
| Provider Name | Leeann Gumulauskas |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144565284 PECOS PAC ID: 6901317973 Enrollment ID: I20250617003238 |
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