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NPI Code Detail

MEDICARE: FAMILY COUNSELING AND MEDIATION SERVICES LLC

MEDICARE: FAMILY COUNSELING AND MEDIATION 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
1251S00000XCommunity/Behavioral Health Agency6401009641MI

General Provider Information

NPI Number : 1700288081
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY COUNSELING AND MEDIATION SERVICES LLC
Provider Business Mailing Address
First Line : 4017 W MAIN ST STE 100
Second Line : SUITE 100
City : KALAMAZOO
State : MI
Zip : 49006-3731
Country : US
Telephone Number : 269-488-5903
Fax Number : 269-775-1288
Provider Business Practice Location Address
First Line : 4017 W MAIN ST STE 100
Second Line : SUITE 100
City : KALAMAZOO
State : MI
Zip : 49006-3731
Country : US
Telephone Number : 269-488-5903
Fax Number : 269-775-1288
Authorized Official
Title or Position : OWNER
Name : LAURIE SCHEID RUDOLPH
Credential : MA, LPC, CAADC, NCC
Telephone Number : 269-488-5903
Provider Enumeration Date : 09/18/2014
Last Update Date : 06/29/2016

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Directions to “FAMILY COUNSELING AND MEDIATION SERVICES LLC ” Practice Location

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