1164826574 NPI number — SHANDA BERDAN COUNSELING SERVICES

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 1164826574 NPI number — SHANDA BERDAN COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHANDA BERDAN COUNSELING SERVICES
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:
1164826574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 HEBESTREIT ST
Provider Second Line Business Mailing Address:
PO BOX 325
Provider Business Mailing Address City Name:
ROSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48654-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-701-5836
Provider Business Mailing Address Fax Number:
989-685-8363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
337 E HOUGHTON AVE
Provider Second Line Business Practice Location Address:
CLINIC A, RM 5
Provider Business Practice Location Address City Name:
WEST BRANCH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48661-1127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-701-5836
Provider Business Practice Location Address Fax Number:
989-685-8363
Provider Enumeration Date:
10/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BERDAN
Authorized Official First Name:
SHANDA
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
989-701-5836

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  6401013102 , 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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