Provider Demographics
NPI:1538633821
Name:THALIA FERENC LLC
Entity Type:Organization
Organization Name:THALIA FERENC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:THALIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FERENC
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:231-838-2322
Mailing Address - Street 1:6127 BAY SHORE WEST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9173
Mailing Address - Country:US
Mailing Address - Phone:231-838-3222
Mailing Address - Fax:
Practice Address - Street 1:6127 BAY SHORE WEST DR
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9173
Practice Address - Country:US
Practice Address - Phone:231-838-2322
Practice Address - Fax:231-622-8126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900032412OtherPRIORITY HEALTH
MICV0081377OtherSIGMA-VSS
MIMI2873OtherBCBSM