Provider Demographics
NPI:1164570248
Name:MICHIGAN COMPREHENSIVE PROFESSIONAL COUNSELING SERVICES PC
Entity Type:Organization
Organization Name:MICHIGAN COMPREHENSIVE PROFESSIONAL COUNSELING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-752-1668
Mailing Address - Street 1:PO BOX 2203
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48605-2203
Mailing Address - Country:US
Mailing Address - Phone:989-752-1668
Mailing Address - Fax:989-752-9710
Practice Address - Street 1:1300 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4732
Practice Address - Country:US
Practice Address - Phone:989-752-1668
Practice Address - Fax:989-752-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010156891041C0700X
251B00000X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251B00000XAgenciesCase Management
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty