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General NPI Number Information
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NPI Number | 1023260718
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Entity Type | Organization
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Legal Business Name | NORTH LAKES FAMILY CENTER
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 611 E LAKESIDE AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2840
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Country | US
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Telephone | 208-664-5941
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1137
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City | COEUR D ALENE
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State | ID
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Zip | 83816-1137
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Country | US
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Telephone | 208-664-5941
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL WILLIAM MARCEAU
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Credential | LCSW
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Telephone | 208-664-5941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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