MEDICARE: OPEN WINDOW COUNSELING

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

General Provider Information

NPI Number	:	1124785191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN WINDOW COUNSELING

Provider Business Mailing Address
First Line	:	3481 POINTER RD
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9624
Country	:	US
Telephone Number	:	929-787-0640
Fax Number	:

Provider Business Practice Location Address
First Line	:	3481 POINTER RD
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-9624
Country	:	US
Telephone Number	:	929-787-0640
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BROOKE ILLIG
Credential	:	LMSW
Telephone Number	:	929-787-0640

Provider Enumeration Date	:	11/24/2021
Last Update Date	:	11/24/2021

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