| Theresa Callard-moore, Acsw | |
|
6199 Miller Rd Suite A Swartz Creek MI 48473-1585 | |
| (810) 630-0904 | |
| Not Available |
| Full Name | Theresa Callard-moore, Acsw |
|---|---|
| Speciality | Clinic/Center |
| Location | 6199 Miller Rd, Swartz Creek, Michigan |
| Authorized Official Name and Position | Theresa Marie Callard-moore (PRESIDENT) |
| Authorized Official Contact | 8106300904 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theresa Callard-moore, Acsw 6199 Miller Rd Suite A Swartz Creek MI 48473-1585 Ph: (810) 630-0904 | Theresa Callard-moore, Acsw 6199 Miller Rd Suite A Swartz Creek MI 48473-1585 Ph: (810) 630-0904 |
| NPI Number | 1174706048 |
|---|---|
| Provider Enumeration Date | 12/13/2007 |
| Last Update Date | 12/13/2007 |
| Medicare PECOS PAC ID | 8224000286 |
|---|---|
| Medicare Enrollment ID | O20040810000850 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174706048 | NPI | - | NPPES |
| 1235158627 | Other | MI | NPI |
| 8008976950 | Other | MI | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 6801067098 (Michigan) | Primary |
| Provider Name | Theresa Callard-moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235158627 PECOS PAC ID: 6901878982 Enrollment ID: I20040811000236 |
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