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General NPI Number Information
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NPI Number | 1780028787
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Entity Type | Organization
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Legal Business Name | BLUE HORIZON
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Dates
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Enumeration Date | 04/20/2013
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Last Update Date | 04/20/2013
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Provider Practice Location Address
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Address Line | 501 W HARRIE ST
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City | NEWBERRY
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State | MI
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Zip | 49868-1226
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Country | US
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Telephone | 906-322-6277
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Fax |
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Provider Business Mailing Address
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Address Line | 501 W HARRIE ST
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City | NEWBERRY
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State | MI
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Zip | 49868-1226
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JOSEPH PHILIP SMITHSON
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Credential | LMSW
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Telephone | 906-322-6277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801086974
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License Number State | MI
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