| Amy Park-goeddeke,lmsw, L.l.c | |
|
12151 15 Mile Rd Sterling Heights MI 48312-5120 | |
| (248) 921-7649 | |
| Not Available |
| Full Name | Amy Park-goeddeke,lmsw, L.l.c |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 12151 15 Mile Rd, Sterling Heights, Michigan |
| Authorized Official Name and Position | Amy Park-goeddeke (DIRECTOR) |
| Authorized Official Contact | 2489217649 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy Park-goeddeke,lmsw, L.l.c 13335 15 Mile Rd # 258 Sterling Heights MI 48312-4271 Ph: (248) 921-7649 | Amy Park-goeddeke,lmsw, L.l.c 12151 15 Mile Rd Sterling Heights MI 48312-5120 Ph: (248) 921-7649 |
| NPI Number | 1124681341 |
|---|---|
| Provider Enumeration Date | 04/15/2019 |
| Last Update Date | 04/15/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124681341 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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