Healthcare Provider Details

I. General information

NPI: 1023614930
Provider Name (Legal Business Name): NORTHWEST COUNSELING AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N MICHIGAN AVE STE B
BIG RAPIDS MI
49307-1481
US

IV. Provider business mailing address

106 N MICHIGAN AVE STE B
BIG RAPIDS MI
49307-1481
US

V. Phone/Fax

Practice location:
  • Phone: 231-373-5798
  • Fax: 833-957-0137
Mailing address:
  • Phone: 231-373-5798
  • Fax: 833-957-0137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILIP ANTHONY HIMEBAUGH
Title or Position: OWNER
Credential: LPC
Phone: 231-373-5798