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General NPI Number Information
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NPI Number | 1104373075
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Entity Type | Organization
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Legal Business Name | PETOSKEY PROFESSIONAL COUNSELORS, LLC
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 422 E MITCHELL ST SUITE 4
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City | PETOSKEY
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State | MI
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Zip | 49770-2602
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Country | US
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Telephone | 231-881-6194
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30
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City | PETOSKEY
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State | MI
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Zip | 49770-0030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROFESSIONAL COUNSELOR
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Name | SHERRY LEEANN GUTHRIE
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Credential | LPC
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Telephone | 231-881-6194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6401010243
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License Number State | MI
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