Provider Demographics
NPI:1164634929
Name:P.O.M. COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:P.O.M. COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:IDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-539-0238
Mailing Address - Street 1:27875 BERRYWOOD LN UNIT 88
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4057
Mailing Address - Country:US
Mailing Address - Phone:248-539-0238
Mailing Address - Fax:
Practice Address - Street 1:27875 BERRYWOOD LN UNIT 88
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4057
Practice Address - Country:US
Practice Address - Phone:248-539-0238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010744281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N11750Medicare ID - Type Unspecified