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NPI Code Detail

MEDICARE: SECOND STORY COUNSELING II LLC

MEDICARE: SECOND STORY COUNSELING II LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1013460716
Entity Type Code : Organization
Provider Name (Legal Business Name) : SECOND STORY COUNSELING II LLC
Provider Business Mailing Address
First Line : 7678 COTTONWOOD DR STE C
Second Line :
City : JENISON
State : MI
Zip : 49428-7312
Country : US
Telephone Number : 616-821-8723
Fax Number :
Provider Business Practice Location Address
First Line : 3424 CHICAGO DR STE 205
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-1411
Country : US
Telephone Number : 616-426-9034
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MICHAEL WALTON
Credential : LPC
Telephone Number : 616-426-9034
Provider Enumeration Date : 07/28/2016
Last Update Date : 12/27/2021

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