=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316540099
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K. H. COUNSELING AND SUPERVISORY SERVICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2020
-----------------------------------------------------
Last Update Date | 11/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 S AUBURN RD
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48611-9366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-402-0847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 734 E BEAVER RD
-----------------------------------------------------
City | KAWKAWLIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48631-9114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | KAREN HEINRICHQ
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 989-402-0847
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------