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General NPI Number Information
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NPI Number | 1780034611
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Entity Type | Organization
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Legal Business Name | NORTH STAR WELLNESS CENTER LLC
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 2535 E MOUNT HOPE AVE
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City | LANSING
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State | MI
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Zip | 48910-1913
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Country | US
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Telephone | 517-999-9003
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Fax | 517-372-2542
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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 | 866-776-7556
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Authorized Official
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Title or Position | CREDENTIALING
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Name | 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 | 6801087140
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License Number State | MI
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