Provider Demographics
NPI:1558748038
Name:PROFESSIONAL COUNSELORS OF LANSING
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELORS OF LANSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:LAQUITA
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLPC, FLE
Authorized Official - Phone:517-394-0929
Mailing Address - Street 1:913 W HOLMES RD
Mailing Address - Street 2:SUITE A125
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0426
Mailing Address - Country:US
Mailing Address - Phone:517-394-0929
Mailing Address - Fax:517-394-0959
Practice Address - Street 1:913 W HOLMES RD
Practice Address - Street 2:SUITE A125
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-394-0929
Practice Address - Fax:517-394-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014380101YP2500X
MI6401014378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty