Healthcare Provider Details

I. General information

NPI: 1003366162
Provider Name (Legal Business Name): UP NORTH FAMILY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 E MITCHELL ST STE 11
PETOSKEY MI
49770-2616
US

IV. Provider business mailing address

PO BOX 2257
CHESTERTON IN
46304-0357
US

V. Phone/Fax

Practice location:
  • Phone: 231-838-7837
  • Fax:
Mailing address:
  • Phone: 219-926-8320
  • Fax: 219-926-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHAD ALEXANDER
Title or Position: OWNER
Credential: LLPC
Phone: 231-838-7837