Healthcare Provider Details

I. General information

NPI: 1386660892
Provider Name (Legal Business Name): LOUIS A BERSINE LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 COLLEGE AVE
ESCANABA MI
49829-9591
US

IV. Provider business mailing address

2500 7TH AVE S STE 100
ESCANABA MI
49829-1176
US

V. Phone/Fax

Practice location:
  • Phone: 906-233-1236
  • Fax: 906-233-1235
Mailing address:
  • Phone: 906-233-1236
  • Fax: 906-233-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6301008428
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401000436
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: