Healthcare Provider Details

I. General information

NPI: 1932945342
Provider Name (Legal Business Name): WAVE COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2024
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 S WATER ST
MARINE CITY MI
48039-1694
US

IV. Provider business mailing address

343 N WILLIAM ST
MARINE CITY MI
48039-3706
US

V. Phone/Fax

Practice location:
  • Phone: 810-202-2662
  • Fax:
Mailing address:
  • Phone: 734-205-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TANYA BISHOP
Title or Position: OWNER
Credential: LMSW
Phone: 734-205-7888