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General NPI Number Information
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NPI Number | 1306387931
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Entity Type | Organization
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Legal Business Name | TRILLIUMWOOD COUNSELING SERVICES
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 4851 COUNTY ROAD 135
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City | MC MILLAN
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State | MI
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Zip | 49853-9452
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Country | US
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Telephone | 906-235-6750
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Fax |
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Provider Business Mailing Address
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Address Line | 4851 COUNTY ROAD 135
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City | MCMILLAN
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State | MI
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Zip | 49853
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Country | US
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Telephone | 906-235-6750
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MR. TIMOTHY ALAN EVANS FILLMORE
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Credential | MS, LMSW
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Telephone | 906-235-6750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 6801093490
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License Number State | MI
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