Healthcare Provider Details

I. General information

NPI: 1679049746
Provider Name (Legal Business Name): SEBALY COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W WASHINGTON ST
MARQUETTE MI
49855-4368
US

IV. Provider business mailing address

2438 DIVISION ST APT 5
MARQUETTE MI
49855-8813
US

V. Phone/Fax

Practice location:
  • Phone: 906-428-6881
  • Fax:
Mailing address:
  • Phone: 906-428-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ELSA DENISE GALLIPPO-SEBALY
Title or Position: MANAGER
Credential:
Phone: 906-428-6881