Provider Demographics
NPI:1366624116
Name:NORTH COAST COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:NORTH COAST COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYMENT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, NCC, ICAADC
Authorized Official - Phone:906-523-5580
Mailing Address - Street 1:300 DUNSTAN STREET
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930
Mailing Address - Country:US
Mailing Address - Phone:906-523-5580
Mailing Address - Fax:888-873-8402
Practice Address - Street 1:300 DUNSTAN ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-2178
Practice Address - Country:US
Practice Address - Phone:906-523-5580
Practice Address - Fax:888-873-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007378101YA0400X, 101YM0800X, 101YP2500X, 251B00000X, 251S00000X
MI68010329141041C0700X
MI68010899151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20366Medicare UPIN
MI20378Medicare PIN
MI20351Medicare UPIN
MIOP223320OtherMEDICARE ID
MI20386Medicare UPIN
MI1712452Medicaid