Healthcare Provider Details

I. General information

NPI: 1730370206
Provider Name (Legal Business Name): PARK PLACE COUNSELING & ASSOCIATE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 S KALAMAZOO MALL SUITE 250
KALAMAZOO MI
49007-4877
US

IV. Provider business mailing address

157 S KALAMAZOO MALL SUITE 250
KALAMAZOO MI
49007-4877
US

V. Phone/Fax

Practice location:
  • Phone: 269-383-1440
  • Fax: 269-383-9781
Mailing address:
  • Phone: 269-383-1440
  • Fax: 269-383-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD A MCLEAN
Title or Position: DIRECTOR
Credential: MA LLP LPC CAAC
Phone: 269-383-1440