MEDICARE: CHARLENE ANN PAHL LMSW ACSW

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	6801062387	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8008948970	OTHER	MI	BCBS OF MI

General Provider Information

NPI Number	:	1134197593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE ANN PAHL LMSW ACSW

Provider Business Mailing Address
First Line	:	212 KENT ST STE 5
Second Line	:	CHILD AND FAMILY WELLNESS COUNSELING CTR
City	:	PORTLAND
State	:	MI
Zip	:	48875
Country	:	US
Telephone Number	:	517-647-4600
Fax Number	:	517-647-4600

Provider Business Practice Location Address
First Line	:	212 KENT ST STE 5
Second Line	:	CHILD AND FAMILY WELLNESS COUNSELING CTR
City	:	PORTLAND
State	:	MI
Zip	:	48875
Country	:	US
Telephone Number	:	517-647-4600
Fax Number	:	517-647-4600

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/08/2007

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