Provider Demographics
NPI:1679714539
Name:COUNSELING RESOURCES
Entity Type:Organization
Organization Name:COUNSELING RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLEICH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:269-982-2955
Mailing Address - Street 1:812 SHIP ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2183
Mailing Address - Country:US
Mailing Address - Phone:269-982-2955
Mailing Address - Fax:269-982-1897
Practice Address - Street 1:812 SHIP ST STE B
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2183
Practice Address - Country:US
Practice Address - Phone:269-982-2955
Practice Address - Fax:269-982-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801021227305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP2741OMedicare PIN