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NPI Code Detail

MEDICARE: HAWTHORN HIVE LLC

MEDICARE: HAWTHORN HIVE LLC
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1932825981
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAWTHORN HIVE LLC
Provider Business Mailing Address
First Line : PO BOX 6463
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49696-6463
Country : US
Telephone Number : 231-590-8650
Fax Number : 231-642-9101
Provider Business Practice Location Address
First Line : 1212 VETERANS DR STE 206
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-4734
Country : US
Telephone Number : 231-590-8650
Fax Number : 231-642-9101
Authorized Official
Title or Position : OWNER - SOLE PROPRIETOR LLC
Name : KARI LYN DE BOER
Credential : LPC, ATR, RYT
Telephone Number : 231-590-8650
Provider Enumeration Date : 10/12/2022
Last Update Date : 10/12/2022

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Directions to “HAWTHORN HIVE LLC ” Practice Location

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