=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316124019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DISCOVERY COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2008
-----------------------------------------------------
Last Update Date | 01/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 296 S MAIN ST
-----------------------------------------------------
City | BRITTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49229-9797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-488-2545
-----------------------------------------------------
Fax | 517-451-5415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 S MAIN ST
-----------------------------------------------------
City | BRITTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49229-9797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-488-2545
-----------------------------------------------------
Fax | 517-451-5415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. ROBERT LYNN WRIGHT
-----------------------------------------------------
Credential | MACP LLP
-----------------------------------------------------
Telephone | 517-488-2545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 6301013432
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 6301013432
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------