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General NPI Number Information
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NPI Number | 1821477845
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Entity Type | Organization
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Legal Business Name | THE MEN'S COUNSELING CENTER OF NORTHERN MICHIGAN, LLC
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 2202 MITCHELL PARK DR SUITE 2B
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City | PETOSKEY
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State | MI
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Zip | 49770-8897
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Country | US
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Telephone | 231-487-0025
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Fax | 231-487-1754
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Provider Business Mailing Address
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Address Line | 2202 MITCHELL PARK DR SUITE 2B
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City | PETOSKEY
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State | MI
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Zip | 49770-8897
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Country | US
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Telephone | 231-487-0025
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Fax | 231-487-1754
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MR. CHARLES DAVID DONALDSON
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Credential | LLP
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Telephone | 231-487-0025
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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 | 6301009941
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License Number State | MI
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