Provider Demographics
NPI:1033655246
Name:SMALL PINE TREE COUNSELING
Entity Type:Organization
Organization Name:SMALL PINE TREE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTERLY-JAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:906-228-3092
Mailing Address - Street 1:238 S FRANCIS MINE DR
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-9077
Mailing Address - Country:US
Mailing Address - Phone:906-228-3092
Mailing Address - Fax:906-273-1434
Practice Address - Street 1:104 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4318
Practice Address - Country:US
Practice Address - Phone:906-228-3092
Practice Address - Fax:906-273-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010905541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty