| Midwest Behavioral Clinic Llc | |
|
210 W Highland Rd Ste 102 Highland MI 48357-4573 | |
| (248) 529-3167 | |
| Not Available |
| Full Name | Midwest Behavioral Clinic Llc |
|---|---|
| Speciality | Psychologist |
| Location | 210 W Highland Rd Ste 102, Highland, Michigan |
| Authorized Official Name and Position | Mary Beth Houpt (CREDENTIALING) |
| Authorized Official Contact | 5176769788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Behavioral Clinic Llc Po Box 10 Mason MI 48854-0010 Ph: () - | Midwest Behavioral Clinic Llc 210 W Highland Rd Ste 102 Highland MI 48357-4573 Ph: (248) 529-3167 |
| NPI Number | 1487146684 |
|---|---|
| Provider Enumeration Date | 06/04/2018 |
| Last Update Date | 12/18/2018 |
| Medicare PECOS PAC ID | 0446503130 |
|---|---|
| Medicare Enrollment ID | O20181026000018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487146684 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 6301014043 (Michigan) | Primary |
| Provider Name | Jennifer L Chapuseaux |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831249895 PECOS PAC ID: 0244284826 Enrollment ID: I20050307000390 |
| Provider Name | Jackson Edwin Turner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316060114 PECOS PAC ID: 6709961626 Enrollment ID: I20080317000223 |
| Provider Name | Jennifer Edwards-mayes |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1104067206 PECOS PAC ID: 3577867688 Enrollment ID: I20160210002288 |
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