Healthcare Provider Details

I. General information

NPI: 1033527577
Provider Name (Legal Business Name): ANN GENSON MA-LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MAIN ST
SCOTTVILLE MI
49454-1042
US

IV. Provider business mailing address

101 N MAIN ST
SCOTTVILLE MI
49454-1042
US

V. Phone/Fax

Practice location:
  • Phone: 231-936-1128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014000
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: