MEDICARE: THE CONNECTED COLLECTIVE WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	104100000X	Social Worker
2	106H00000X	Marriage & Family Therapist
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1972399350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CONNECTED COLLECTIVE WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	6120 STADIUM DR STE 100
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-3022
Country	:	US
Telephone Number	:	269-366-0650
Fax Number	:	269-762-5957

Provider Business Practice Location Address
First Line	:	6120 STADIUM DR STE 100
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-3022
Country	:	US
Telephone Number	:	269-366-0650
Fax Number	:	269-762-5957

Authorized Official
Title or Position	:	OWNER/CLINICAL DIRECTOR
Name	:	SARAH GOOD
Credential	:	LPC, LMFT
Telephone Number	:	269-808-8059

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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