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General NPI Number Information
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NPI Number | 1538202056
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Entity Type | Organization
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Legal Business Name | NEW HOPE COUNSELING AGENCY, PLLC
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 2808 LINCOLN AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-3309
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Country | US
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Telephone | 269-429-8770
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Fax | 269-429-8770
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Provider Business Mailing Address
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Address Line | 2808 LINCOLN AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-3309
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Country | US
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Telephone | 269-429-8770
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Fax | 269-429-8770
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Authorized Official
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Title or Position | SOLE MEMBER-PRESIDENT
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Name | REBECCA J RUSSELL
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Credential | M.A., L.L.P.
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Telephone | 269-429-8770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6301010732
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License Number State | MI
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