MEDICARE: RENEWAL COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801091453	MI

General Provider Information

NPI Number	:	1093136376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEWAL COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	4994 PARK LAKE ROAD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4994 PARK LAKE RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-3836
Country	:	US
Telephone Number	:	517-896-4060
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MONICA POFF
Credential	:	LMSW
Telephone Number	:	517-896-4060

Provider Enumeration Date	:	01/03/2014
Last Update Date	:	01/03/2014

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