MEDICARE: RECORE COUNSELING AND CONSULTING, INC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1417592122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECORE COUNSELING AND CONSULTING, INC

Provider Business Mailing Address
First Line	:	17214 VAN WAGONER RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9780
Country	:	US
Telephone Number	:	616-405-4188
Fax Number	:

Provider Business Practice Location Address
First Line	:	17214 VAN WAGONER RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-9780
Country	:	US
Telephone Number	:	616-405-4188
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT DECKERT
Credential	:	MA, LPC
Telephone Number	:	616-405-4188

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	11/18/2019

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