Healthcare Provider Details

I. General information

NPI: 1609573740
Provider Name (Legal Business Name): CALM LAKE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E MAIN ST UNIT 71
NILES MI
49120-2376
US

IV. Provider business mailing address

210 E MAIN ST UNIT 71
NILES MI
49120-2376
US

V. Phone/Fax

Practice location:
  • Phone: 269-340-2770
  • Fax:
Mailing address:
  • Phone: 269-340-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DAWN RACHT
Title or Position: OWNER
Credential: LPC
Phone: 269-340-2770