Healthcare Provider Details

I. General information

NPI: 1154054435
Provider Name (Legal Business Name): FRANK EDWARD STAAB LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E COLBY ST
WHITEHALL MI
49461-1113
US

IV. Provider business mailing address

516 E COLBY ST
WHITEHALL MI
49461-1113
US

V. Phone/Fax

Practice location:
  • Phone: 231-893-8336
  • Fax:
Mailing address:
  • Phone: 231-893-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451022339
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: