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General NPI Number Information
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NPI Number | 1831911445
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Entity Type | Organization
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Legal Business Name | BRANCH OUT COUNSELING CENTER
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Dates
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Enumeration Date | 10/26/2024
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Last Update Date | 10/26/2024
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Provider Practice Location Address
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Address Line | 2193 ASSOCIATION DR
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City | OKEMOS
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State | MI
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Zip | 48864-4903
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Country | US
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Telephone | 517-258-0354
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Fax |
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Provider Business Mailing Address
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Address Line | 2193 ASSOCIATION DR
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City | OKEMOS
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State | MI
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Zip | 48864-4903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SARAH DYMOND
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Credential |
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Telephone | 517-258-0354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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