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General NPI Number Information
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NPI Number | 1396150546
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Entity Type | Organization
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Legal Business Name | BLUE SEAHORSE INC.
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 101 E DELAWARE ST
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City | DECATUR
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State | MI
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Zip | 49045-1131
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Country | US
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Telephone | 269-244-3577
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Fax | 269-409-3983
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Provider Business Mailing Address
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Address Line | 101 E DELAWARE ST
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City | DECATUR
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State | MI
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Zip | 49045-1131
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Country | US
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Telephone | 269-244-3577
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Fax | 269-409-3983
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | MR. MIKE GEORGE SIVER
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Credential |
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Telephone | 269-244-3577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | SA0800033
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SA0800033
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License Number State | MI
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