Basic Information
| Provider Information | |||||||||
| NPI: | 1467573691 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEBRA SCHECK, MSW, ACSW PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3791 KLAIS DR | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483482359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486938880 | ||||||||
| FaxNumber: | 2483917478 | ||||||||
| Practice Location | |||||||||
| Address1: | 3694 CLARKSTON RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483485213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486938880 | ||||||||
| FaxNumber: | 2483917478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHECK | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2486938880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801021651 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 251193 | 01 | MI | MENTAL HEALTH NETWORK | OTHER | 8008907620 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER |