Healthcare Provider Details

I. General information

NPI: 1003329582
Provider Name (Legal Business Name): GILBERT COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4084 OKEMOS RD
OKEMOS MI
48864-3258
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-347-4848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401010373
License Number StateMI

VIII. Authorized Official

Name: MARYBETH HOUPT
Title or Position: CREDENTIALING
Credential:
Phone: 517-676-9788