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General NPI Number Information
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NPI Number | 1619022027
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Entity Type | Organization
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Legal Business Name | MAPLEVIEW CONSULTATION CENTER PC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 181 W MICHIGAN AVE SUITE 3
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City | PAW PAW
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State | MI
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Zip | 49079-1432
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Country | US
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Telephone | 269-657-6025
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Fax | 269-657-5198
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Provider Business Mailing Address
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Address Line | 181 W MICHIGAN AVE SUITE 3
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City | PAW PAW
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State | MI
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Zip | 49079-1432
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Country | US
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Telephone | 269-657-6025
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Fax | 269-657-5198
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LAURIE FRENCH
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Credential | LMSW
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Telephone | 269-657-6025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301010127
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6401006865
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801059976
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License Number State | MI
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