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General NPI Number Information
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NPI Number | 1497135453
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Entity Type | Organization
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Legal Business Name | MACOMB COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 21400 DOGLEG DR
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City | MACOMB
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State | MI
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Zip | 48042-4326
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Country | US
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Telephone | 586-262-7809
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Fax | 586-598-7403
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Provider Business Mailing Address
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Address Line | 21400 DOGLEG DRIVE
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City | MACOMB
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State | MI
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Zip | 48042
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Country | US
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Telephone | 586-262-7809
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Fax | 586-598-7403
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MICHELLE L. SIEV
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Credential | MA, LPC, NCC
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Telephone | 586-262-7809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 6401013489
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License Number State | MI
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