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General NPI Number Information
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NPI Number | 1417457391
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Entity Type | Organization
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Legal Business Name | FAMILY COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 1611 W CENTRE AVE STE 103
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City | PORTAGE
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State | MI
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Zip | 49024-5339
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Country | US
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Telephone | 269-251-9818
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | MASON
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State | MI
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Zip | 48854-0010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MARY BETH HOUPT
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Credential |
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Telephone | 517-676-9788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401013354
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License Number State | MI
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