MEDICARE: PAINT CREEK COUNSELING, PLLC

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	6401014928	MI

General Provider Information

NPI Number	:	1730547589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAINT CREEK COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	2362 LASSITER DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1519
Country	:	US
Telephone Number	:	947-517-4012
Fax Number	:

Provider Business Practice Location Address
First Line	:	2362 LASSITER DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1519
Country	:	US
Telephone Number	:	947-517-4012
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR/OWNER
Name	:	ANGELA MARIE BAAN EDDY
Credential	:	M.A., L.L.P.C.
Telephone Number	:	947-517-4012

Provider Enumeration Date	:	02/08/2016
Last Update Date	:	02/08/2016

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