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General NPI Number Information
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NPI Number | 1427569979
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Entity Type | Organization
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Legal Business Name | DEARMOND PROFESSIONAL SERVICES LLC
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 8240 EMBURY RD
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City | GRAND BLANC
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State | MI
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Zip | 48439-7113
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Country | US
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Telephone | 810-624-0234
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Fax | 810-396-6119
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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 | 517-676-9788
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801094720
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License Number State | MI
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