Provider Demographics
NPI:1417257189
Name:GENESIS COUNSELING SERVICES
Entity Type:Organization
Organization Name:GENESIS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MACHELLE
Authorized Official - Middle Name:DIA
Authorized Official - Last Name:VIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:LLMFT
Authorized Official - Phone:269-998-4388
Mailing Address - Street 1:68155 26TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:MI
Mailing Address - Zip Code:49065-9615
Mailing Address - Country:US
Mailing Address - Phone:269-998-4388
Mailing Address - Fax:269-624-2495
Practice Address - Street 1:304 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1012
Practice Address - Country:US
Practice Address - Phone:269-998-4388
Practice Address - Fax:269-624-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID4854G251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health