Carla Anne Koon, LLPC
Individual provider Active NPI Mental Health Counselor · Grand Blanc, MI
NPI 1770146284 · NPPES record last updated Apr 17, 2023
Key facts
- NPI
- 1770146284
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 6451007253 (MI)
- Practice address
- 8308 Office Park Dr Ste 3
Grand Blanc, MI 48439-2075 - Phone
- (810) 584-0070
- NPI assigned
- Apr 19, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Creekside Counseling Group LLC
Practice addresses (Care Compare)
10801 S Saginaw St
Suite D
Grand Blanc, MI 48439-8126
Phone (810) 771-4074
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240806000142 | MI | Practitioner - Mental Health Counselor | 3072050228 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6451007253 | MI | MD | Mental Health Counselor |
| 6802080026 | MI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Creekside Counseling Group LLC | Mental Health | Current |
Accepting new patients |
Locations
10801 S Saginaw St
Ste D
Grand Blanc, MI 48439
Phone (810) 771-4074
10683 S Saginaw St
Ste B
Grand Blanc, MI 48439
Phone (810) 694-3576
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802080026 | MI | |
| Mental Health Counselor | 101YM0800X | 6451007253 | MI | Yes |
Addresses
Primary practice location
8308 Office Park Dr Ste 3
Grand Blanc, MI 48439-2075
Mailing address
10223 Heather Ridge CT
Goodrich, MI 48438-9063
Phone (810) 513-9006
Other providers in Grand Blanc, MI
- Cody Martin Knuppenburg
- Christopher Kocharians
- Evan Kohler
- Prasad Kommareddi
- Alicia Konecny
- Olivia Korhonen
- Joel Fredric Kortge
- Erica Kovacs
- Sherry Lin Kowal
- Rhonda Lee Kozumplik
All providers in Grand Blanc, MI · Mental Health Counselor in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.