Healthcare Provider Details

I. General information

NPI: 1164570248
Provider Name (Legal Business Name): MICHIGAN COMPREHENSIVE PROFESSIONAL COUNSELING SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N MICHIGAN AVE
SAGINAW MI
48602-4732
US

IV. Provider business mailing address

PO BOX 2203
SAGINAW MI
48605-2203
US

V. Phone/Fax

Practice location:
  • Phone: 989-752-1668
  • Fax: 989-752-9710
Mailing address:
  • Phone: 989-752-1668
  • Fax: 989-752-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801015689
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. HAZEL E. MILAM
Title or Position: PRESIDENT
Credential: LMSW
Phone: 989-752-1668