Healthcare Provider Details

I. General information

NPI: 1508299207
Provider Name (Legal Business Name): FOR THE FAMILY COUNSELING SERVICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3466 MAIN ST SUITE 1
DECKERVILLE MI
48427-7709
US

IV. Provider business mailing address

4022 PARISVILLE RD
RUTH MI
48470-9759
US

V. Phone/Fax

Practice location:
  • Phone: 989-912-0258
  • Fax: 810-539-6358
Mailing address:
  • Phone: 989-912-0258
  • Fax: 810-539-6358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090691
License Number StateMI

VIII. Authorized Official

Name: BUFFIE KLEE
Title or Position: OWNER
Credential: MSW
Phone: 989-912-0258