| Lakeshore Community Counseling Center Pllc | |
|
9116 E 13th St Suite B Cadillac MI 49601-8126 | |
| (231) 878-3059 | |
| Not Available |
| Full Name | Lakeshore Community Counseling Center Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 9116 E 13th St, Cadillac, Michigan |
| Authorized Official Name and Position | Craig Allen Derror (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2318783059 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Community Counseling Center Pllc 9116 E 13th St Suite B Cadillac MI 49601-8126 Ph: (231) 878-3059 | Lakeshore Community Counseling Center Pllc 9116 E 13th St Suite B Cadillac MI 49601-8126 Ph: (231) 878-3059 |
| NPI Number | 1225376056 |
|---|---|
| Provider Enumeration Date | 01/29/2013 |
| Last Update Date | 01/29/2013 |
| Medicare PECOS PAC ID | 5294107652 |
|---|---|
| Medicare Enrollment ID | O20230213000001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225376056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 6301013463 (Michigan) | Primary |
| Provider Name | Craig A Derror |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124366950 PECOS PAC ID: 0446512925 Enrollment ID: I20180321000683 |
| Provider Name | Stephanie Lynn Merklinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205358603 PECOS PAC ID: 2769715515 Enrollment ID: I20190610001990 |
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