1013378850 NPI number — DAWN WOOD COUNSELING, LLC

Table of content: (NPI 1013378850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013378850 NPI number — DAWN WOOD COUNSELING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAWN WOOD COUNSELING, 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:
1013378850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1918 STEARNS AVE
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:
49008-1844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-808-0160
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3503 GREENLEAF BLVD STE 202
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:
49008-2580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-808-0160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WOOD
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
269-808-0160

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6801096207 , 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: 0C90618 . This is a "BLUE CROSS BLUE SHIELD, BLUE CARE NETWORK OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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