Provider Demographics
NPI:1578834156
Name:GREAT LAKES COUNSELING P C
Entity Type:Organization
Organization Name:GREAT LAKES COUNSELING P C
Other - Org Name:DAVID D. LUCE, ACSW
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUCE
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:231-263-2268
Mailing Address - Street 1:1419 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9272
Mailing Address - Country:US
Mailing Address - Phone:231-263-2268
Mailing Address - Fax:
Practice Address - Street 1:1419 NIGHTINGALE LN
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649-9272
Practice Address - Country:US
Practice Address - Phone:231-263-2268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801064141251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION37850Medicare UPIN