Healthcare Provider Details

I. General information

NPI: 1144492000
Provider Name (Legal Business Name): MARIANNE KOTECKI MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 N CLARE AVE
HARRISON MI
48625-9194
US

IV. Provider business mailing address

789 N CLARE AVE
HARRISON MI
48625-9194
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2141
  • Fax: 989-539-2143
Mailing address:
  • Phone: 989-539-2141
  • Fax: 989-539-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number640101285
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401010285
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: