Healthcare Provider Details
I. General information
NPI: 1295898385
Provider Name (Legal Business Name): PROFESSIONAL OUTREACH COUNSELING SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 12/19/2006
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
34841 VETERANS PLZ
WAYNE MI
48184-1733
US
IV. Provider business mailing address
34841 VETERANS PLZ
WAYNE MI
48184-1733
US
V. Phone/Fax
- Phone: 313-292-7640
- Fax: 313-292-9270
- Phone: 313-292-7640
- Fax: 313-292-9270
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 6801077910 |
| License Number State | MI |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 6401008900 |
| License Number State | MI |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 6401007447 |
| License Number State | MI |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | 6401009679 |
| License Number State | MI |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 6401008194 |
| License Number State | MI |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 6401009106 |
| License Number State | MI |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | 009925 |
| License Number State | MI |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | 6301009054 |
| License Number State | MI |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103TS0200X |
| Taxonomy | School Psychologist |
| License Number | 6301010278 |
| License Number State | MI |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 104100000X |
| Taxonomy | Social Worker |
| License Number | 6801083794 |
| License Number State | MI |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 6801064655 |
| License Number State | MI |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 6801063516 |
| License Number State | MI |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 122300000X |
| Taxonomy | Dentist |
| License Number | 2901019243 |
| License Number State | MI |
| # 14 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | 6301009925 |
| License Number State | MI |
VIII. Authorized Official
Name:
COLIN
F.
KING
Title or Position: OWNER
Credential: PHD. LP.
Phone: 313-292-7640
