MEDICARE: NYA COUNSELING PLLC

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	:	1639801483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYA COUNSELING PLLC

Provider Business Mailing Address
First Line	:	3520 FERNWOOD LN
Second Line	:
City	:	MASON
State	:	MI
Zip	:	48854-9385
Country	:	US
Telephone Number	:	517-896-5900
Fax Number	:	833-596-1611

Provider Business Practice Location Address
First Line	:	6920 S CEDAR ST STE 8
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48911-6924
Country	:	US
Telephone Number	:	517-896-5900
Fax Number	:	833-596-1611

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	MR. ADDAM KILPATRICK
Credential	:	LPC
Telephone Number	:	517-896-5900

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	06/29/2022

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