Healthcare Provider Details

I. General information

NPI: 1710164652
Provider Name (Legal Business Name): PARKSIDE FAMILY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W MAUMEE ST
ADRIAN MI
49221-1901
US

IV. Provider business mailing address

805 W MAUMEE ST
ADRIAN MI
49221-1901
US

V. Phone/Fax

Practice location:
  • Phone: 517-266-8880
  • Fax: 517-266-8881
Mailing address:
  • Phone: 517-266-8880
  • Fax: 517-266-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: THERESE LANGAN
Title or Position: PARTNER
Credential: LMSW
Phone: 517-266-8880