Healthcare Provider Details

I. General information

NPI: 1467292847
Provider Name (Legal Business Name): SCOTT M RESCHKE MA, LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 SLEIGHT RD
BATH MI
48808-9405
US

IV. Provider business mailing address

5315 SLEIGHT RD
BATH MI
48808-9405
US

V. Phone/Fax

Practice location:
  • Phone: 517-282-6708
  • Fax:
Mailing address:
  • Phone: 517-282-6708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023563
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: