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General NPI Number Information
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NPI Number | 1649458126
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Entity Type | Organization
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Legal Business Name | CHANGING SEASONS COUNSELING CENTER
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 2012 10TH ST
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City | MENOMINEE
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State | MI
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Zip | 49858-2194
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Country | US
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Telephone | 906-863-5646
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Fax | 906-863-1078
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Provider Business Mailing Address
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Address Line | 2012 10TH ST
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City | MENOMINEE
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State | MI
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Zip | 49858-2194
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Country | US
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Telephone | 906-863-5646
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Fax | 906-863-1078
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | DR. MICHAEL JAY GIBSON
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Credential | ED.D
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Telephone | 906-863-5646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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