=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225214992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRIEF MATTERS, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2008
-----------------------------------------------------
Last Update Date | 01/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1214 COOPER ST SUITE 201
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49202-2496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-789-7227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 576
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49204-0576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. BEVERLY K. WILSON
-----------------------------------------------------
Credential | BSN,RNC, MA, FT, LPC
-----------------------------------------------------
Telephone | 517-789-7227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 6401009068
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------