Healthcare Provider Details

I. General information

NPI: 1699151845
Provider Name (Legal Business Name): WOW COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 W HOLMES RD
LANSING MI
48910-0426
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 586-221-0674
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013683
License Number StateMI

VIII. Authorized Official

Name: MS. MARYBETH HOUPT
Title or Position: CREDENTIALING
Credential:
Phone: 517-676-9898