Provider Demographics
NPI:1831856806
Name:ALISA GLASS-SCHMOCK
Entity type:Organization
Organization Name:ALISA GLASS-SCHMOCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLASS-SCHMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-375-4018
Mailing Address - Street 1:2160 HAMILTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1699
Mailing Address - Country:US
Mailing Address - Phone:517-375-4018
Mailing Address - Fax:
Practice Address - Street 1:2160 HAMILTON RD STE C
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1699
Practice Address - Country:US
Practice Address - Phone:517-375-4018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty