| N/a | |
|
834 King Hwy Ste 120 Kalamazoo MI 49001-2579 | |
| (269) 598-2837 | |
| (844) 279-3926 |
| Full Name | N/a |
|---|---|
| Speciality | Clinic/Center |
| Location | 834 King Hwy Ste 120, Kalamazoo, Michigan |
| Authorized Official Name and Position | Deanna Omoniyi (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2695982837 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a 834 King Hwy Ste 120 Kalamazoo MI 49001-2579 Ph: (269) 598-2837 | N/a 834 King Hwy Ste 120 Kalamazoo MI 49001-2579 Ph: (269) 598-2837 |
| NPI Number | 1992268627 |
|---|---|
| Provider Enumeration Date | 04/10/2019 |
| Last Update Date | 05/02/2022 |
| Certification Date | 05/02/2022 |
| Medicare PECOS PAC ID | 3173948486 |
|---|---|
| Medicare Enrollment ID | O20200804001589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992268627 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Deanna F Omoniyi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982945101 PECOS PAC ID: 0941515290 Enrollment ID: I20150814013505 |
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