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General NPI Number Information
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NPI Number | 1780207092
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Entity Type | Individual
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Provider Name | MARY INSALACO
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Gender | Female
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 261 M 62
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City | CASSOPOLIS
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State | MI
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Zip | 49031-1034
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Country | US
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Telephone | 269-445-3874
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Fax |
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Provider Business Mailing Address
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Address Line | 2222 W GRAND RIVER AVE STE A
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City | OKEMOS
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State | MI
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Zip | 48864-1604
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Country | US
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Telephone | 269-421-1926
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401222880
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License Number State | MI
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