Healthcare Provider Details

I. General information

NPI: 1972513612
Provider Name (Legal Business Name): JANE MARIE BASLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 HENRY ST
PORT HURON MI
48060-2526
US

IV. Provider business mailing address

5415 BASLER RD
CARSONVILLE MI
48419-9796
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-9700
  • Fax:
Mailing address:
  • Phone: 810-657-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6802003180
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: