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NPI Code Detail

MEDICARE: MR. JOHN EDWARD SCALISE M.A.

MEDICARE: MR. JOHN EDWARD SCALISE M.A.
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
1101YM0800XMental Health Counselor6401002793MI
2103TC0700XClinical Psychologist6301005924MI
31041C0700XClinical Social Worker6801062435MI

General Provider Information

NPI Number : 1346320454
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN EDWARD SCALISE M.A.
Provider Business Mailing Address
First Line : 304 E HIGH ST
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-3552
Country : US
Telephone Number : 989-772-3948
Fax Number :
Provider Business Practice Location Address
First Line : 301 S CRAPO ST
Second Line : SUITE 200
City : MOUNT PLEASANT
State : MI
Zip : 48858-2941
Country : US
Telephone Number : 989-772-5938
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 05/12/2011

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