Healthcare Provider Details

I. General information

NPI: 1750122768
Provider Name (Legal Business Name): 1308 COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 W SAGINAW ST
EAST LANSING MI
48823-2434
US

IV. Provider business mailing address

1422 W SAGINAW ST
EAST LANSING MI
48823-2434
US

V. Phone/Fax

Practice location:
  • Phone: 734-249-8341
  • Fax:
Mailing address:
  • Phone: 734-249-8341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ISAAC PEETERS
Title or Position: OWNER
Credential: LPC
Phone: 517-775-7211