Geodes, Anxiety and Trauma Clinic, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801085334 Issued in MI

Legal business name

GEODES, ANXIETY AND TRAUMA CLINIC, LLC

Practice address

1164 James Savage Rd Ste E
Midland, MI 48640-6843

Phone

(989) 513-5107

Fax

(855) 483-9638

NPI assigned

Jul 13, 2015

Last updated

Aug 11, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Lynette Bourlakas-Maurer, LMSW, CBISNPI 1649418708

Title

Owner, Clinical Social Worker

Phone

(989) 513-5107

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole L Bourlakas-Maurer, LMSW, CBIS

  • Clinical Social Worker
  • Midland, MI
  • NPI 1649418708
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439251200000",
    "number": "1861876468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1164 JAMES SAVAGE RD STE E",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486406843",
            "telephone_number": "989-513-5107",
            "fax_number": "855-483-9638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1164 JAMES SAVAGE RD STE E",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486406843",
            "telephone_number": "989-513-5107",
            "fax_number": "855-483-9638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEODES, ANXIETY AND TRAUMA CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-13",
        "last_updated": "2015-08-11",
        "status": "A",
        "authorized_official_last_name": "BOURLAKAS-MAURER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "LYNETTE",
        "authorized_official_title_or_position": "OWNER,  CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "989-513-5107",
        "authorized_official_credential": "LMSW, CBIS"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801085334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "730195",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenna Gembrowski
• Jennifer Lynn Geneseo, LMSW
• Jayne Marie Genovese
• Robert A. Genovese, MD
• Natalynn Gentle
• Alexis Anne George
• Stephanie Nicole Gerds
• Emily Kay Getchel
• Lindsey Ghiringhelli, PHARMD, BCGP
• Ashley Michelle Ghose, DPT

• Clinical Social Worker in Midland, MI
• Providers in Midland, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.