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General NPI Number Information
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NPI Number | 1912327396
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Entity Type | Organization
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Legal Business Name | EURISKO VOCATIONAL SERVICES, LLC
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 3030 MATTHEW RD
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City | NILES
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State | MI
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Zip | 49120-9022
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Country | US
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Telephone | 269-277-3070
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 MATTHEW RD
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City | NILES
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State | MI
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Zip | 49120-9022
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Country | US
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Telephone | 269-277-3070
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ROMME JOHNSON
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Credential | LPC
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Telephone | 269-277-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401011740
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401011898
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License Number State | MI
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