| Lake's Edge Therapy Services Llc | |
|
212 1/2 Washington Ave Ste 3 Grand Haven MI 49417-3316 | |
| (616) 419-8591 | |
| Not Available |
| Full Name | Lake's Edge Therapy Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 212 1/2 Washington Ave Ste 3, Grand Haven, Michigan |
| Authorized Official Name and Position | Catherine Anne Kolacz (OWNER) |
| Authorized Official Contact | 6165024586 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake's Edge Therapy Services Llc 59 N Division Ave Holland MI 49424-6456 Ph: (616) 502-4586 | Lake's Edge Therapy Services Llc 212 1/2 Washington Ave Ste 3 Grand Haven MI 49417-3316 Ph: (616) 419-8591 |
| NPI Number | 1164205159 |
|---|---|
| Provider Enumeration Date | 08/15/2023 |
| Last Update Date | 08/26/2023 |
| Certification Date | 08/26/2023 |
| Medicare PECOS PAC ID | 5597129981 |
|---|---|
| Medicare Enrollment ID | O20230919001583 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164205159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Catherine A Kolacz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134396427 PECOS PAC ID: 1850566951 Enrollment ID: I20111219000066 |
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