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General NPI Number Information
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NPI Number | 1588464366
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Entity Type | Organization
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Legal Business Name | NEWAYGO COUNTY COUNSELING, PLLC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 4040 W 72ND ST
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City | FREMONT
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State | MI
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Zip | 49412-9254
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Country | US
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Telephone | 231-924-5309
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 CORNER ST
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City | FREMONT
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State | MI
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Zip | 49412-9405
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Country | US
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Telephone | 616-279-9825
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MRS. KIRA LYNN RAQUET
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Credential | LCSW
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Telephone | 616-279-9825
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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 |
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License Number State |
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