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General NPI Number Information
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NPI Number | 1215507090
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Entity Type | Organization
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Legal Business Name | PURUCKER COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 06/25/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 100 S. JEFFERSON ST. B
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City | HASTINGS
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State | MI
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Zip | 49058
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Country | US
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Telephone | 269-331-0283
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Fax |
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Provider Business Mailing Address
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Address Line | 816 S CHURCH ST
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City | HASTINGS
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State | MI
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Zip | 49058-2212
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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
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Name | COLETTE PURUCKER
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Credential |
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Telephone | 269-389-0037
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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 |
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License Number State |
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