Provider Demographics
NPI:1659720548
Name:ADVANCED COUNSELING AND THERAPY SERVICES
Entity Type:Organization
Organization Name:ADVANCED COUNSELING AND THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-483-2461
Mailing Address - Street 1:2020 RAYBROOK ST SE
Mailing Address - Street 2:STE 305
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7717
Mailing Address - Country:US
Mailing Address - Phone:517-483-2461
Mailing Address - Fax:517-323-9531
Practice Address - Street 1:2020 RAYBROOK ST SE
Practice Address - Street 2:STE 305
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7717
Practice Address - Country:US
Practice Address - Phone:517-483-2461
Practice Address - Fax:517-323-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010902261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty