| Rochester Evidence-based Psychotherapy Clinic, Pllc | |
|
414 S Main St Suite 201 Rochester MI 48307 | |
| (248) 568-5180 | |
| (248) 429-2132 |
| Full Name | Rochester Evidence-based Psychotherapy Clinic, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 414 S Main St, Rochester, Michigan |
| Authorized Official Name and Position | Adam G. Hamilton (OWNER) |
| Authorized Official Contact | 2485685180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rochester Evidence-based Psychotherapy Clinic, Pllc 414 S Main St Suite 201 Rochester MI 48307-2068 Ph: (248) 568-5180 | Rochester Evidence-based Psychotherapy Clinic, Pllc 414 S Main St Suite 201 Rochester MI 48307 Ph: (248) 568-5180 |
| NPI Number | 1326580432 |
|---|---|
| Provider Enumeration Date | 11/07/2016 |
| Last Update Date | 06/22/2018 |
| Medicare PECOS PAC ID | 5496007254 |
|---|---|
| Medicare Enrollment ID | O20181008000217 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326580432 | NPI | - | NPPES |
| 1417247768 | Other | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 6401011306 (Michigan) | Primary |
| 106H00000X | Marriage & Family Therapist | 4101006671 (Michigan) | Secondary |
| Provider Name | Mark A Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053364307 PECOS PAC ID: 3678585346 Enrollment ID: I20060620000283 |
| Provider Name | Linda A Burton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568748267 PECOS PAC ID: 5597984294 Enrollment ID: I20140911000648 |
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