Provider Demographics
NPI:1407318835
Name:COUNSELOR BOB INC
Entity Type:Organization
Organization Name:COUNSELOR BOB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:KING
Authorized Official - Suffix:II
Authorized Official - Credentials:MA, LPC, CAADC
Authorized Official - Phone:810-820-1357
Mailing Address - Street 1:731 E MOUNT MORRIS ST # 6
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-2070
Mailing Address - Country:US
Mailing Address - Phone:810-820-1357
Mailing Address - Fax:810-368-4936
Practice Address - Street 1:731 E MOUNT MORRIS ST STE 6
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-2070
Practice Address - Country:US
Practice Address - Phone:810-820-1357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty