Provider Demographics
NPI:1437721420
Name:A COLLECTIVE COUNSELING LIFELINE, LLC
Entity Type:Organization
Organization Name:A COLLECTIVE COUNSELING LIFELINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BRADEN-HORSTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-720-4510
Mailing Address - Street 1:215 N WATER ST STE 139
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2807
Mailing Address - Country:US
Mailing Address - Phone:989-720-4510
Mailing Address - Fax:
Practice Address - Street 1:215 N WATER ST STE 139
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2807
Practice Address - Country:US
Practice Address - Phone:989-720-4510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)