1174670798 NPI number — ARTHUR M DAGLOW COUNSELING CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174670798 NPI number — ARTHUR M DAGLOW COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTHUR M DAGLOW COUNSELING CENTER
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:
DAYSPRING COUNSELING ASSOCIATES
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:
1174670798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 LAKE EASTBROOK BLVD SE
Provider Second Line Business Mailing Address:
SUITE 280
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546-5938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-942-7331
Provider Business Mailing Address Fax Number:
616-942-8807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 LAKE EASTBROOK BLVD SE
Provider Second Line Business Practice Location Address:
SUITE 280
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-5938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-942-7331
Provider Business Practice Location Address Fax Number:
616-942-8807
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAGLOW
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
MERTON
Authorized Official Title or Position:
OWNER, THERAPIST
Authorized Official Telephone Number:
616-942-7331

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801002754 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 4101005607 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8008933650 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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