MEDICARE: DIANE HELLNER M.A., CAC 1

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1811102023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE HELLNER M.A., CAC 1

Provider Business Mailing Address
First Line	:	909 BURR ST
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1949 LANSING AVE
Second Line	:	SUITE 'B'
City	:	JACKSON
State	:	MI
Zip	:	49202-2190
Country	:	US
Telephone Number	:	517-784-2929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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