Provider Demographics
NPI:1396021473
Name:FAMILY RESOURCE COUNSELING & LEARNING CENTER INC
Entity Type:Organization
Organization Name:FAMILY RESOURCE COUNSELING & LEARNING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:989-635-2400
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-0325
Mailing Address - Country:US
Mailing Address - Phone:989-635-2400
Mailing Address - Fax:
Practice Address - Street 1:3149 MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1255
Practice Address - Country:US
Practice Address - Phone:989-635-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGM007346103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G645021682Medicare PIN