=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659805497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MBS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2017
-----------------------------------------------------
Last Update Date | 04/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3815 W SAINT JOSEPH ST SUITE B301
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48917-3666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-391-4934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48854-0010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING
-----------------------------------------------------
Name | MARY BETH HOUPT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 517-676-9788
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 4010115925
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------