1477795664 NPI number — HACKLEY LIFE COUNSELING

Table of content: (NPI 1477795664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477795664 NPI number — HACKLEY LIFE COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HACKLEY LIFE COUNSELING
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:
MERCY HEALTH PARTNERS - LIFE COUNSELING
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:
1477795664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 E SOUTHERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49442-5041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-726-3582
Provider Business Mailing Address Fax Number:
231-722-6933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 E SOUTHERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-726-3582
Provider Business Practice Location Address Fax Number:
231-722-6933
Provider Enumeration Date:
04/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LOHMAN
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL DIRECTOR
Authorized Official Telephone Number:
231-727-4499

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  610004 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20363 . This is a "BCBS SUBSTANCE ABUSE FACILITY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OF11088 . This is a "BCBS SOCIAL WORKER GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0910713 . This is a "BCBS - OUTPATIENT PSYCHIATRIC FACILITY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OF11343 . This is a "BCBS PSYCHOLOGIST GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com