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General NPI Number Information
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NPI Number | 1063979144
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Entity Type | Organization
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Legal Business Name | NEW RIVER COUNSELING, PLLC
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 2663 44TH ST SW STE 106
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City | WYOMING
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State | MI
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Zip | 49519-4189
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Country | US
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Telephone | 269-359-3269
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Fax |
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Provider Business Mailing Address
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Address Line | 167 N DRAKE RD # 19788
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City | KALAMAZOO
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State | MI
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Zip | 49009-9998
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Country | US
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Telephone | 269-359-3269
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/THERAPIST
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Name | STEPHEN ANTHONY SILLIMAN
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Credential | LPC
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Telephone | 269-359-3269
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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 |
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License Number State |
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