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General NPI Number Information
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NPI Number | 1962995829
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY COUSNELING SERVICE LLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 105 W HILLSDALE ST
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City | LANSING
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State | MI
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Zip | 48933
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Country | US
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Telephone | 734-623-9082
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Fax |
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Provider Business Mailing Address
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Address Line | 3122 AVALON ST
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City | LANSING
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State | MI
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Zip | 48911-1805
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Country | US
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Telephone | 517-256-4178
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Fax |
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Authorized Official
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Title or Position | COUNSELOR/OWNER
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Name | JOSEPH AARON SCOTT HETHORN
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Credential | MA, LLPC
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Telephone | 734-623-9082
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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 |
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License Number State |
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