MEDICARE: NEUMEYER THERAPEUTIC SERVICES LLC

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1568004745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUMEYER THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	12395 WINDCLIFF
Second Line	:
City	:	DAVISBURG
State	:	MI
Zip	:	48350-1678
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8323 OFFICE PARK DR STE D
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2068
Country	:	US
Telephone Number	:	810-262-0594
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MARY BETH HOUPT
Credential	:
Telephone Number	:	517-676-9788

Provider Enumeration Date	:	10/09/2019
Last Update Date	:	02/12/2020

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