Provider Demographics
NPI:1184199168
Name:NORTHERN STAR COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:NORTHERN STAR COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA J
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC
Authorized Official - Phone:906-362-4174
Mailing Address - Street 1:308 CLEVELAND AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-1842
Mailing Address - Country:US
Mailing Address - Phone:906-362-4174
Mailing Address - Fax:906-204-7186
Practice Address - Street 1:308 CLEVELAND AVE STE 311
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-1842
Practice Address - Country:US
Practice Address - Phone:906-362-4174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1346639903Medicaid