MEDICARE: CALMWAVE COUNSELING PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1144187048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALMWAVE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	3115 CANDLESTICK LN
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2303
Country	:	US
Telephone Number	:	989-670-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 CANDLESTICK LN
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2303
Country	:	US
Telephone Number	:	989-670-6611
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRADLEY FOTOPOULOS
Credential	:	LMSW
Telephone Number	:	989-670-6611

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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