MEDICARE: ACTS CHRISTIAN COUNSELING, LLC

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
1	103TC0700X	Clinical Psychologist	6301011617	MI
2	1041C0700X	Clinical Social Worker	6801092886	MI

General Provider Information

NPI Number	:	1407242654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTS CHRISTIAN COUNSELING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-0307
Country	:	US
Telephone Number	:	810-270-2323
Fax Number	:	810-270-2324

Provider Business Practice Location Address
First Line	:	4070 HURON ST STE A
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-8664
Country	:	US
Telephone Number	:	810-270-2323
Fax Number	:	810-270-2324

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN LOVELETTE
Credential	:
Telephone Number	:	810-660-8275

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	08/26/2019

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