1487873659 NPI number — BETHESDA COUNSELING SEVICES LLC

Table of content: BRIAN LANDON TRAN (NPI 1104402601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487873659 NPI number — BETHESDA COUNSELING SEVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHESDA COUNSELING SEVICES LLC
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:
Provider Other Organization Name Type Code:
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:
1487873659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10040 STADIUM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49009-9426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-375-2833
Provider Business Mailing Address Fax Number:
269-375-2838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 W MICHIGAN AVE STE 243 # 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49006-5892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-375-2833
Provider Business Practice Location Address Fax Number:
269-375-2838
Provider Enumeration Date:
04/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PHELPS
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
269-375-2833

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401004079 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC0700X , with the licence number: 6301001601 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TC1900X , with the licence number: 6301007397 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 6401004079 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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