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NPI Code Detail

MEDICARE: HAUTUMN VANGEISON

MEDICARE: HAUTUMN VANGEISON
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
1101YP2500XProfessional Counselor6401015731MI

General Provider Information

NPI Number : 1821534207
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAUTUMN VANGEISON
Provider Business Mailing Address
First Line : 116 TULGEYWOOD LANE
Second Line :
City : WHITEHALL
State : MI
Zip : 49461
Country : US
Telephone Number : 760-805-6399
Fax Number :
Provider Business Practice Location Address
First Line : 3611 HENRY ST
Second Line :
City : NORTON SHORES
State : MI
Zip : 49441-4705
Country : US
Telephone Number : 760-805-6399
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2017
Last Update Date : 01/10/2017

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Directions to “ HAUTUMN VANGEISON ” Practice Location

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