Provider Demographics
NPI:1477795664
Name:HACKLEY LIFE COUNSELING
Entity Type:Organization
Organization Name:HACKLEY LIFE COUNSELING
Other - Org Name:MERCY HEALTH PARTNERS - LIFE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-727-4499
Mailing Address - Street 1:125 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5041
Mailing Address - Country:US
Mailing Address - Phone:231-726-3582
Mailing Address - Fax:231-722-6933
Practice Address - Street 1:125 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442
Practice Address - Country:US
Practice Address - Phone:231-726-3582
Practice Address - Fax:231-722-6933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH MUSKEGON / TRINITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-02
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI610004103TC0700X
MI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20363OtherBCBS SUBSTANCE ABUSE FACILITY
MIOF11088OtherBCBS SOCIAL WORKER GROUP
MI0910713OtherBCBS - OUTPATIENT PSYCHIATRIC FACILITY
MIOF11343OtherBCBS PSYCHOLOGIST GROUP
MIOF11343OtherBCBS PSYCHOLOGIST GROUP
MIOF11088OtherBCBS SOCIAL WORKER GROUP
MI20363OtherBCBS SUBSTANCE ABUSE FACILITY