Healthcare Provider Details

I. General information

NPI: 1073989141
Provider Name (Legal Business Name): THE FOUR HEALTH FAMILY RESOURCE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 N BRIDGE ST
SARANAC MI
48881
US

IV. Provider business mailing address

92 N BRIDGE ST P O BOX 178
SARANAC MI
48881-5102
US

V. Phone/Fax

Practice location:
  • Phone: 616-642-6466
  • Fax: 616-642-6621
Mailing address:
  • Phone: 616-642-6466
  • Fax: 616-642-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014973
License Number StateMI

VIII. Authorized Official

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