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General NPI Number Information
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NPI Number | 1376178020
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Entity Type | Organization
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Legal Business Name | PRO-ACTIVE COUNSELING LLC
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Dates
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Enumeration Date | 03/03/2020
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 1410 84TH ST SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-9344
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Country | US
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Telephone | 616-292-1995
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Fax | 616-827-2277
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Provider Business Mailing Address
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Address Line | PO BOX 519
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City | BYRON CENTER
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State | MI
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Zip | 49315-0519
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Country | US
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Telephone | 616-292-1995
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Fax | 616-827-2277
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANGELA MUSSELMAN
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Credential | LLP
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Telephone | 616-292-1995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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