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General NPI Number Information
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NPI Number | 1730693060
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Entity Type | Organization
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Legal Business Name | MACROBIOTIC ED COUNSELING & PSYCHO
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 164 KINGSBROOK AVE
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City | ANN ARBOR
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State | MI
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Zip | 48103-6603
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Country | US
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Telephone | 586-944-8741
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Fax | 586-944-2234
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Provider Business Mailing Address
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Address Line | 164 KINGSBROOK AVE
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City | ANN ARBOR
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State | MI
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Zip | 48103-6603
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Country | US
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Telephone | 586-944-8741
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Fax | 586-944-2234
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. BONNIE AYER BREIDENBACH
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Credential | MALLP, LPC
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Telephone | 586-944-8741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401005658
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License Number State | MI
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