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General NPI Number Information
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NPI Number | 1043469307
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Entity Type | Organization
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Legal Business Name | CROSSROADS OF MUSKEGON , LLC
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 1541 PECK ST
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City | MUSKEGON
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State | MI
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Zip | 49441-2127
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Country | US
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Telephone | 231-747-7530
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Fax | 231-747-7531
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Provider Business Mailing Address
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Address Line | 1541 PECK ST
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City | MUSKEGON
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State | MI
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Zip | 49441-2127
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Country | US
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Telephone | 231-747-7530
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Fax | 231-747-7531
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. NANCY CLAIRE DEVINE
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Credential | MD
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Telephone | 231-670-5538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4301082875
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License Number State | MI
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