Healthcare Provider Details

I. General information

NPI: 1477795664
Provider Name (Legal Business Name): HACKLEY LIFE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E SOUTHERN AVE
MUSKEGON MI
49442
US

IV. Provider business mailing address

125 E SOUTHERN AVE
MUSKEGON MI
49442-5041
US

V. Phone/Fax

Practice location:
  • Phone: 231-726-3582
  • Fax: 231-722-6933
Mailing address:
  • Phone: 231-726-3582
  • Fax: 231-722-6933

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 StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number610004
License Number StateMI

VIII. Authorized Official

Name: MICHELLE LOHMAN
Title or Position: REGIONAL DIRECTOR
Credential:
Phone: 231-727-4499