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General NPI Number Information
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NPI Number | 1235634908
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Entity Type | Individual
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Provider Name | ANNETTE LYNN MAXWELL LLPC
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Gender | Female
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 805 SUPERIOR ST
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City | PORT HURON
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State | MI
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Zip | 48060-3771
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Country | US
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Telephone | 810-966-1972
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Fax |
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Provider Business Mailing Address
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Address Line | 4079 JANICE AVE
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3771
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Country | US
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Telephone | 810-333-3429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6401013836
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License Number State | MI
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