=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225428121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD GUY FURST LPC, LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2015
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 DEPOT ST
-----------------------------------------------------
City | HANCOCK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49930-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-870-0963
-----------------------------------------------------
Fax | 906-523-9602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16688 BARAGA PLAINS RD
-----------------------------------------------------
City | BARAGA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49908-9158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-870-0963
-----------------------------------------------------
Fax | 906-523-9602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 11030
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 3623
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 6401014122
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 4101006613
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------