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General NPI Number Information
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NPI Number | 1124491600
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Entity Type | Individual
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Provider Name | BENJAMIN ROY BOOKIE M.A.
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Gender | Male
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 318 S BRIDGE ST STE A
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City | BELDING
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State | MI
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Zip | 48809-1764
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Country | US
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Telephone | 616-902-9007
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Fax |
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Provider Business Mailing Address
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Address Line | 3087 POTTERS RD
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City | IONIA
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State | MI
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Zip | 48846-8514
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Country | US
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Telephone | 616-902-4677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6401015165
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401015165
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License Number State | MI
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