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NPI Code Detail

MEDICARE: THREE CS PROFESSIONAL SERVICES LLC

MEDICARE: THREE CS PROFESSIONAL SERVICES 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1598573503
Entity Type Code : Organization
Provider Name (Legal Business Name) : THREE CS PROFESSIONAL SERVICES LLC
Provider Business Mailing Address
First Line : 300 E 6TH ST
Second Line :
City : SHELBY
State : MI
Zip : 49455-1150
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 E 6TH ST
Second Line :
City : SHELBY
State : MI
Zip : 49455-1150
Country : US
Telephone Number : 616-450-2284
Fax Number :
Authorized Official
Title or Position : CO-OWNER
Name : DR. DERIK VAN BAALE
Credential :
Telephone Number : 616-450-2284
Provider Enumeration Date : 12/21/2024
Last Update Date : 12/21/2024

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