1952969370 NPI number — PREMIER COUNSELING AND WELLNESS INSTITUTE

Table of content: MR. GEOFFREY STEVEN VANDERHYDE LAC (NPI 1871764852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952969370 NPI number — PREMIER COUNSELING AND WELLNESS INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER COUNSELING AND WELLNESS INSTITUTE
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1952969370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1494
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKEMOS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48805-1494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 W LAKE LANSING RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-8452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-618-0579
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SHILLING
Authorized Official First Name:
KILEY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
517-231-3962

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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