| Mid-america Psychological Services Pc | |
|
8036 Moors Bridge Rd Suite 2 Portage MI 49024-4419 | |
| (269) 327-1438 | |
| (269) 327-6454 |
| Full Name | Mid-america Psychological Services Pc |
|---|---|
| Speciality | Social Worker |
| Location | 8036 Moors Bridge Rd, Portage, Michigan |
| Authorized Official Name and Position | Jean Lavanne Ogilvie (PRESIDENT) |
| Authorized Official Contact | 2693738878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid-america Psychological Services Pc Po Box 2585 Portage MI 49081-2585 Ph: (269) 373-8878 | Mid-america Psychological Services Pc 8036 Moors Bridge Rd Suite 2 Portage MI 49024-4419 Ph: (269) 327-1438 |
| NPI Number | 1376682641 |
|---|---|
| Provider Enumeration Date | 02/05/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1759374812 |
|---|---|
| Medicare Enrollment ID | O20040415000412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376682641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 071800 (Michigan) | Primary |
| Provider Name | David L Russell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548362171 PECOS PAC ID: 1052484748 Enrollment ID: I20080714000280 |
| Provider Name | David Duane Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184765943 PECOS PAC ID: 2567504905 Enrollment ID: I20100122000267 |
| Provider Name | Ann E Muntter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811083413 PECOS PAC ID: 1951552561 Enrollment ID: I20121107000749 |
| Provider Name | Patricia Edd Murray |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740371426 PECOS PAC ID: 6608027842 Enrollment ID: I20121115000329 |
| Provider Name | Lisa Turk Sonday |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104262997 PECOS PAC ID: 7719109909 Enrollment ID: I20141103001049 |
| Provider Name | Matthew M Zarantonello |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497774368 PECOS PAC ID: 5294054235 Enrollment ID: I20150424001495 |
| Provider Name | Jeffrey G White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538213103 PECOS PAC ID: 5294880795 Enrollment ID: I20180718003487 |
| Provider Name | Charles Clearwater |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790134740 PECOS PAC ID: 3072864388 Enrollment ID: I20180926001778 |
| Provider Name | Mary Theresa Zirpoli |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548367493 PECOS PAC ID: 6608200977 Enrollment ID: I20191218002905 |
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