| Triad Associates Pc | |
|
8062 Ortonville Road Clarkston MI 48348 | |
| (248) 625-2970 | |
| (248) 625-6829 |
| Full Name | Triad Associates Pc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 8062 Ortonville Road, Clarkston, Michigan |
| Authorized Official Name and Position | Fred J Baumann (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Contact | 2486252970 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Triad Associates Pc 8062 Ortonville Road Clarkston MI 48348-4456 Ph: (248) 625-2970 | Triad Associates Pc 8062 Ortonville Road Clarkston MI 48348 Ph: (248) 625-2970 |
| NPI Number | 1801953674 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8527016245 |
|---|---|
| Medicare Enrollment ID | O20050110000779 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801953674 | NPI | - | NPPES |
| 630712 | Other | MI | SUBSTANCE ABUSE |
| 17781 | Other | CARF |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Irina Fiksman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205917028 PECOS PAC ID: 9931184629 Enrollment ID: I20050105000705 |
| Provider Name | Ellen I Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407986813 PECOS PAC ID: 4082628391 Enrollment ID: I20060125000895 |
| Provider Name | Robert J Lagrou |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629279351 PECOS PAC ID: 3779645270 Enrollment ID: I20081217000396 |
| Provider Name | Christian T Osborn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629232798 PECOS PAC ID: 4981890670 Enrollment ID: I20101119000840 |
| Provider Name | Rachel L Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912206798 PECOS PAC ID: 7214166388 Enrollment ID: I20140212001676 |
| Provider Name | Dana Jeffery |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669846614 PECOS PAC ID: 1254748924 Enrollment ID: I20210324001806 |
| Provider Name | Dena Marie Schwartz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164925483 PECOS PAC ID: 3173990843 Enrollment ID: I20221109001922 |
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