MEDICARE: HACKLEY LIFE COUNSELING

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	610004	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	028369	OTHER	MI	VALUE OPTIONS SUB ABUSE
2	031611000	OTHER	MI	MAGELLAN GROUP #
3	OF11343	OTHER	MI	BCBS PSYCHOLOGIST GROUP
4	20363	OTHER	MI	BCBS - SUBSTANCE ABUSE FACILITY
5	OF10118	OTHER	MI	BCS SOCIAL WORKER GROUP
6	030234	OTHER	MI	VALUE OPTIONS MENTAL HEAL
7	0910713	OTHER	MI	BCBS - OPC

General Provider Information

NPI Number	:	1912954322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HACKLEY LIFE COUNSELING

Provider Business Mailing Address
First Line	:	125 E SOUTHERN AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5041
Country	:	US
Telephone Number	:	231-726-3582
Fax Number	:	231-722-6933

Provider Business Practice Location Address
First Line	:	125 E SOUTHERN AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5041
Country	:	US
Telephone Number	:	231-726-3582
Fax Number	:	231-722-6933

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. SANDRA KLEIN HORSMAN
Credential	:
Telephone Number	:	231-726-3582

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	08/04/2015

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Directions to “HACKLEY LIFE COUNSELING ” Practice Location

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