MEDICARE: HEALING PLACE 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

General Provider Information

NPI Number	:	1730572777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING PLACE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	800 E ELLIS RD STE 111
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5622
Country	:	US
Telephone Number	:	231-288-6591
Fax Number	:	231-354-3517

Provider Business Practice Location Address
First Line	:	800 E ELLIS RD STE 111
Second Line	:
City	:	NORTON SHORES
State	:	MI
Zip	:	49441-5622
Country	:	US
Telephone Number	:	231-288-6591
Fax Number	:	231-354-3517

Authorized Official
Title or Position	:	THERAPIST
Name	:	DAWN M WILBURN
Credential	:	LPC
Telephone Number	:	231-288-6591

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	08/23/2024

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