MEDICARE: WAYNE COUNSELING & CONSULTATION, 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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1588528087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE COUNSELING & CONSULTATION, LLC

Provider Business Mailing Address
First Line	:	2280 S 11TH ST # 203
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-1910
Country	:	US
Telephone Number	:	269-598-4109
Fax Number	:	269-532-7910

Provider Business Practice Location Address
First Line	:	2280 S 11TH ST # 203
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-1910
Country	:	US
Telephone Number	:	269-598-4109
Fax Number	:	269-532-7910

Authorized Official
Title or Position	:	THERAPIST
Name	:	MR. ANDRE JAMAR WAYNE
Credential	:	MA
Telephone Number	:	269-598-4109

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/12/2025

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