=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033343843
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAELAN COUNSELING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2009
-----------------------------------------------------
Last Update Date | 03/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 N 3RD ST
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49120-2655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-683-8972
-----------------------------------------------------
Fax | 269-683-0449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 N 3RD ST
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49120-2655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-683-8972
-----------------------------------------------------
Fax | 269-683-0449
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MARC T MILHANDER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 269-683-8972
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6301007537
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------