Healthcare Provider Details

I. General information

NPI: 1548304306
Provider Name (Legal Business Name): KAREN JO HEINRICH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 E HURON RD
AU GRES MI
48703-9419
US

IV. Provider business mailing address

2348 E HURON RD
AU GRES MI
48703-9419
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-8636
  • Fax:
Mailing address:
  • Phone: 989-362-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401006724
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: