MEDICARE: THOMAS JOE AKALIS L.L.P. L.M.S.W. M.A

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	103TC0700X	Clinical Psychologist	6301004024	MI
2	1041C0700X	Clinical Social Worker	6801015536	MI

General Provider Information

NPI Number	:	1750567871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOE AKALIS L.L.P. L.M.S.W. M.A

Provider Business Mailing Address
First Line	:	8264 MILITARY RD SE
Second Line	:
City	:	FIFE LAKE
State	:	MI
Zip	:	49633-8251
Country	:	US
Telephone Number	:	231-357-3501
Fax Number	:

Provider Business Practice Location Address
First Line	:	8264 MILITARY RD SE
Second Line	:
City	:	FIFE LAKE
State	:	MI
Zip	:	49633-8251
Country	:	US
Telephone Number	:	231-357-3501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2008
Last Update Date	:	01/18/2008

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