1386756153 NPI number — SOUTHWEST COUNSELING SOLUTIONS

Table of content: (NPI 1386756153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386756153 NPI number — SOUTHWEST COUNSELING SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST COUNSELING SOLUTIONS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHWEST CONSELING SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386756153
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/10/2023
NPI Reactivation Date:
02/07/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 WATERMAN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48209-2022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-841-8900
Provider Business Mailing Address Fax Number:
313-841-2276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 WATERMAN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48209-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-841-8900
Provider Business Practice Location Address Fax Number:
313-841-2276
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEFOUR
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
313-481-3102

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 750910836 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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