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General NPI Number Information
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NPI Number | 1831272574
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Entity Type | Organization
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Legal Business Name | LAKESHORE PROFESSIONAL COUNSELING INC
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 447 FIRST STREET
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City | MENOMINEE
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State | MI
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Zip | 49858-3307
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Country | US
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Telephone | 906-864-2590
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Fax | 906-864-3058
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Provider Business Mailing Address
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Address Line | 447 FIRST STREET
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City | MENOMINEE
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State | MI
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Zip | 49858-3307
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Country | US
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Telephone | 906-864-2590
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Fax | 906-864-3058
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | JEANNE M HARPER
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Credential | MPS, FT, BCETS, LBSW
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Telephone | 906-864-2590
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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 | 1500
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License Number State | WI
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