Healthcare Provider Details

I. General information

NPI: 1497375380
Provider Name (Legal Business Name): DISCOVERY COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S STEPHENSON AVE # 203
IRON MOUNTAIN MI
49801-2942
US

IV. Provider business mailing address

PO BOX 842
IRON MOUNTAIN MI
49801-0842
US

V. Phone/Fax

Practice location:
  • Phone: 906-828-5118
  • Fax:
Mailing address:
  • Phone: 906-828-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. CORY JOSEPH VEDIN
Title or Position: LICENSED MASTERS SOCIAL WORKER/OWNE
Credential: LMSW
Phone: 906-828-5118