1821477845 NPI number — THE MEN'S COUNSELING CENTER OF NORTHERN MICHIGAN, LLC

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 1821477845 NPI number — THE MEN'S COUNSELING CENTER OF NORTHERN MICHIGAN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MEN'S COUNSELING CENTER OF NORTHERN MICHIGAN, 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:
1821477845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 MITCHELL PARK DR
Provider Second Line Business Mailing Address:
SUITE 2B
Provider Business Mailing Address City Name:
PETOSKEY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49770-8897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-487-0025
Provider Business Mailing Address Fax Number:
231-487-1754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2202 MITCHELL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
PETOSKEY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49770-8897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-487-0025
Provider Business Practice Location Address Fax Number:
231-487-1754
Provider Enumeration Date:
05/22/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DONALDSON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
231-487-0025

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  6301009941 , 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)





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