1245752344 NPI number — JUNE CASTONGUAY MA, LLPC, CCTP, NCC

Table of content: REBECCA L SMITH (NPI 1639691827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245752344 NPI number — JUNE CASTONGUAY MA, LLPC, CCTP, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTONGUAY
Provider First Name:
JUNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LLPC, CCTP, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTONGUAY
Provider Other First Name:
JUNE
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245752344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 HERITAGE AVE STE A2
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:
48864-2871
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-798-0681
Provider Business Mailing Address Fax Number:
517-347-9622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3899 OKEMOS RD STE A1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-3666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-507-5892
Provider Business Practice Location Address Fax Number:
517-258-2951
Provider Enumeration Date:
07/10/2017

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:  6401016120 , 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)





Copyright © 2007-2026 www.npivalidator.com