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General NPI Number Information
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NPI Number | 1790053270
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Entity Type | Organization
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Legal Business Name | BAY AREA SUBSTANCE EDUCATION SERVICES
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 101 M 66 N
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City | CHARLEVOIX
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State | MI
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Zip | 49720-9338
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Country | US
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Telephone | 231-547-1144
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Fax | 231-547-4970
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Provider Business Mailing Address
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Address Line | 101 M 66 N
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City | CHARLEVOIX
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State | MI
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Zip | 49720-9338
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Country | US
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Telephone | 231-547-1144
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Fax | 231-547-4970
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | CELIA PARTIDA KELLY
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Credential | MA,LPC,CAADC,CTP,
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Telephone | 231-547-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 150013
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License Number State | MI
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