Healthcare Provider Details

I. General information

NPI: 1003633645
Provider Name (Legal Business Name): NORTHERN STAR COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 CLEVELAND AVE STE 204
ISHPEMING MI
49849-1837
US

IV. Provider business mailing address

308 CLEVELAND AVE STE 204
ISHPEMING MI
49849-1837
US

V. Phone/Fax

Practice location:
  • Phone: 906-362-4174
  • Fax:
Mailing address:
  • Phone: 906-362-4174
  • 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: MICHELLE KUPPIN
Title or Position: BILLER
Credential:
Phone: 906-362-4529