Provider Demographics
NPI:1225572597
Name:MONETTE, TINA R (LPC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:R
Last Name:MONETTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MI
Mailing Address - Zip Code:49304-7984
Mailing Address - Country:US
Mailing Address - Phone:231-745-4624
Mailing Address - Fax:231-745-5031
Practice Address - Street 1:17445 PINE RIVER RD
Practice Address - Street 2:
Practice Address - City:LEROY
Practice Address - State:MI
Practice Address - Zip Code:49655-8366
Practice Address - Country:US
Practice Address - Phone:231-876-6527
Practice Address - Fax:231-876-6519
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013739101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor