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General NPI Number Information
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NPI Number | 1760139695
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Entity Type | Individual
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Provider Name | EVIN PAPUGA CRC, LLPC
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Gender | Male
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 132 E GRAND RIVER AVE STE 205
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City | BRIGHTON
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State | MI
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Zip | 48116-1510
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Country | US
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Telephone | 248-408-1429
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Fax |
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Provider Business Mailing Address
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Address Line | 5924 RAUP RD
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City | WHITE LAKE
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State | MI
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Zip | 48383-1163
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Country | US
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Telephone | 248-408-1429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6451021999
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License Number State | MI
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