Healthcare Provider Details

I. General information

NPI: 1649982471
Provider Name (Legal Business Name): LIFE SKILLS NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2022
Last Update Date: 12/26/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MARY ST STE 6
BESSEMER MI
49911-1457
US

IV. Provider business mailing address

101 E MARY ST STE 6
BESSEMER MI
49911-1457
US

V. Phone/Fax

Practice location:
  • Phone: 906-285-2738
  • Fax:
Mailing address:
  • Phone: 906-285-2738
  • Fax: 906-292-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. HARRY SWANSON
Title or Position: CEO
Credential: MA, LPC, CAADC, CSAC
Phone: 906-285-2738