1346004918 NPI number — HARBOUR TOWNE COUNSELING AND PSYCHIATRY, PLLC

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 1346004918 NPI number — HARBOUR TOWNE COUNSELING AND PSYCHIATRY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARBOUR TOWNE COUNSELING AND PSYCHIATRY, PLLC
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:
6
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:
1346004918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 W WALTON AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49440-1360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-722-7980
Provider Business Mailing Address Fax Number:
231-722-7979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3535 PARK STREET
Provider Second Line Business Practice Location Address:
SUITE 101B
Provider Business Practice Location Address City Name:
NORTON SHORES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49444-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-375-7205
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COCHRANE-HOEKSTRA
Authorized Official First Name:
DANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN'S ASSISTANT
Authorized Official Telephone Number:
231-375-7205

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)