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General NPI Number Information
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NPI Number | 1184199168
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Entity Type | Organization
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Legal Business Name | NORTHERN STAR COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 10/05/2018
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 308 CLEVELAND AVE STE 311
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City | ISHPEMING
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State | MI
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Zip | 49849-1842
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Country | US
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Telephone | 906-362-4174
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Fax |
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Provider Business Mailing Address
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Address Line | 308 CLEVELAND AVE STE 311
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City | ISHPEMING
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State | MI
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Zip | 49849-1842
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Country | US
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Telephone | 906-362-4174
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Fax | 906-204-7186
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Authorized Official
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Title or Position | THERAPIST
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Name | MARTHA J POTTER
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Credential | M.S., LPC, NCC
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Telephone | 906-362-4174
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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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