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General NPI Number Information
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NPI Number | 1326606369
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Entity Type | Organization
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Legal Business Name | KALKASKA COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 880 MUNSON AVE STE G
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-3661
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Country | US
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Telephone | 231-944-0384
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2257
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City | CHESTERTON
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State | IN
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Zip | 46304-0357
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Country | US
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Telephone | 219-926-8320
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA LAUREN BERTHELOT
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Credential | LMSW
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Telephone | 231-944-0384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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