MEDICARE: SILVER LAKE COUNSELING

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750078390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER LAKE COUNSELING

Provider Business Mailing Address
First Line	:	15173 NORTH RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1381
Country	:	US
Telephone Number	:	810-428-7909
Fax Number	:

Provider Business Practice Location Address
First Line	:	15173 NORTH RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1381
Country	:	US
Telephone Number	:	810-428-7909
Fax Number	:	810-519-8063

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	TERESA L. FOWLER
Credential	:	LPC
Telephone Number	:	810-428-7909

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	03/06/2025

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