1205855350 NPI number — MS. VICTORIA MARIE NAERT MA, LPC

Table of content: MS. VICTORIA MARIE NAERT MA, LPC (NPI 1205855350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205855350 NPI number — MS. VICTORIA MARIE NAERT MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAERT
Provider First Name:
VICTORIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOUCKAERT
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205855350
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1513 COLUMBUS AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-391-4212
Provider Business Mailing Address Fax Number:
989-391-4214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1513 COLUMBUS AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-391-4212
Provider Business Practice Location Address Fax Number:
989-391-4214
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401009063 , 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: 1013790 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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