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NPI Code Detail

MEDICARE: PROFESSIONAL COUNSELING CENTER,P.C.

MEDICARE: PROFESSIONAL COUNSELING CENTER,P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor740040MI

General Provider Information

NPI Number : 1225049760
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL COUNSELING CENTER,P.C.
Provider Business Mailing Address
First Line : 520 SUPERIOR ST
Second Line :
City : PORT HURON
State : MI
Zip : 48060
Country : US
Telephone Number : 810-984-4202
Fax Number : 810-984-8896
Provider Business Practice Location Address
First Line : 520 SUPERIOR ST
Second Line :
City : PORT HURON
State : MI
Zip : 48060-3838
Country : US
Telephone Number : 810-984-4202
Fax Number : 810-984-8896
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : TERRI LYNN MOSS
Credential :
Telephone Number : 810-294-4880
Provider Enumeration Date : 08/10/2006
Last Update Date : 02/06/2024

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