Healthcare Provider Details

I. General information

NPI: 1306399613
Provider Name (Legal Business Name): HILLSDALE COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 E. COLLEGE ST
HILLSDALE MI
49242
US

IV. Provider business mailing address

33 E COLLEGE ST
HILLSDALE MI
49242-1205
US

V. Phone/Fax

Practice location:
  • Phone: 517-437-7341
  • Fax: 517-607-2222
Mailing address:
  • Phone: 517-437-7341
  • Fax: 517-607-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number012733
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704212731
License Number StateMI

VIII. Authorized Official

Name: MR. RICHARD BROCK LUTZ
Title or Position: DIRECTOR OF HEALTH SERVICES
Credential: MA, LPC
Phone: 517-607-2561