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

Table of content: JUNE CASTONGUAY MA, LLPC, CCTP, NCC (NPI 1245752344)

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)





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