=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265329791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRESCO COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2025
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 BLUE STAR HWY STE E
-----------------------------------------------------
City | DOUGLAS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49406-5135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-745-1322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 973
-----------------------------------------------------
City | DOUGLAS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49406-0973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SARA RUITER
-----------------------------------------------------
Credential | MSW, LMSW
-----------------------------------------------------
Telephone | 616-745-1322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------