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General NPI Number Information
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NPI Number | 1760928816
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Entity Type | Organization
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Legal Business Name | THEIS COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 01/13/2017
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Last Update Date | 01/13/2017
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Provider Practice Location Address
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Address Line | 2199 JOLLY RD SUITE 150
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City | OKEMOS
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State | MI
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Zip | 48864-3968
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Country | US
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Telephone | 517-927-9811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | MASON
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State | MI
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Zip | 48854-0010
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Country | US
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Telephone | 517-676-9788
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | MRS. MARY BETH HOUPT
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Credential |
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Telephone | 517-676-9788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801079869
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License Number State | MI
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