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General NPI Number Information
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NPI Number | 1588090161
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Entity Type | Organization
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Legal Business Name | THIRD LEVEL CRISIS INTERVENTION CENTER, INC.
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 1022 E FRONT ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-2708
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Country | US
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Telephone | 231-922-4802
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Fax | 231-941-5786
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Provider Business Mailing Address
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Address Line | PO BOX 1035
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City | TRAVERSE CITY
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State | MI
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Zip | 49685-1035
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Country | US
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Telephone | 231-922-4802
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Fax | 231-941-5786
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Authorized Official
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Title or Position | CLINICAL SERVICES DIRECTOR
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Name | MICHELE JANNAZZO
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Credential |
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Telephone | 231-922-4802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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