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General NPI Number Information
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NPI Number | 1144525288
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Entity Type | Organization
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Legal Business Name | HACKLEY LIFE COUNSELING
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 125 E SOUTHERN AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-5041
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Country | US
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Telephone | 231-726-3582
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Fax | 231-722-6933
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Provider Business Mailing Address
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Address Line | 125 E SOUTHERN AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-5041
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Country | US
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Telephone | 231-726-3582
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Fax | 231-722-6933
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Authorized Official
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Title or Position | DIRECTOR
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Name | SANDRA KLEIN HORSMAN
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Credential |
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Telephone | 231-726-3582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 610004
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License Number State | MI
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