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General NPI Number Information
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NPI Number | 1114218807
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Entity Type | Organization
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Legal Business Name | BEACON COUNSELING CENTER LLC
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 04/29/2011
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Provider Practice Location Address
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Address Line | 3665 S LAKESHORE DR 3665 SOUTH LAKESHORE DRIVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-8277
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Country | US
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Telephone | 269-429-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 3665 S LAKESHORE DR 3665 SOUTH LAKESHORE DRIVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-8277
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Country | US
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Telephone | 269-429-9000
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | MRS. MARLA JEAN HUTCHINSON
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Credential | LMSW
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Telephone | 269-429-9000
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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 | 6801089570
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License Number State | MI
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