| Lakeshore Integrative Mental Health Services, Llc | |
|
800 E Ellis Rd Mail Box 577, Suite 271 Norton Shores MI 49441-5646 | |
| (231) 799-4850 | |
| (231) 799-4851 |
| Full Name | Lakeshore Integrative Mental Health Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 800 E Ellis Rd, Norton Shores, Michigan |
| Authorized Official Name and Position | Diane Lynn Bruursema (OWNER/CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2317994850 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Integrative Mental Health Services, Llc 800 E Ellis Rd Mail Box 577, Suite 271 Norton Shores MI 49441-5646 Ph: (231) 799-4850 | Lakeshore Integrative Mental Health Services, Llc 800 E Ellis Rd Mail Box 577, Suite 271 Norton Shores MI 49441-5646 Ph: (231) 799-4850 |
| NPI Number | 1447644471 |
|---|---|
| Provider Enumeration Date | 03/27/2015 |
| Last Update Date | 03/27/2015 |
| Medicare PECOS PAC ID | 8022371491 |
|---|---|
| Medicare Enrollment ID | O20180417002105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447644471 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Diane L Bruursema |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487762175 PECOS PAC ID: 5294707204 Enrollment ID: I20040810001205 |
| Provider Name | Letizia M Charleston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386923746 PECOS PAC ID: 2961675293 Enrollment ID: I20111102000638 |
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