1982241964 NPI number — MARQUETTE COUNSELING SERVICE

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 1982241964 NPI number — MARQUETTE COUNSELING SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARQUETTE COUNSELING SERVICE
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:
1982241964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MARQUETTE COUNSELING SERVICES
Provider Second Line Business Mailing Address:
112 W WASHINGTON STREET STE A
Provider Business Mailing Address City Name:
MARQUETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-360-7472
Provider Business Mailing Address Fax Number:
906-475-8748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LORI JOHNSON
Provider Second Line Business Practice Location Address:
112 W WASHINGTON STREET STE A
Provider Business Practice Location Address City Name:
MARQUETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49855-3844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-360-7472
Provider Business Practice Location Address Fax Number:
906-475-8748
Provider Enumeration Date:
12/09/2019

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
LORI
Authorized Official Middle Name:
ANNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
906-360-7472

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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