Provider Demographics
NPI:1689329120
Name:THIRD COAST COUNSELING & CONSULTATION, LLC
Entity Type:Organization
Organization Name:THIRD COAST COUNSELING & CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-328-3756
Mailing Address - Street 1:1514 WEALTHY ST SE STE 236
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2755
Mailing Address - Country:US
Mailing Address - Phone:616-328-3756
Mailing Address - Fax:616-284-2133
Practice Address - Street 1:1514 WEALTHY ST SE STE 236
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2755
Practice Address - Country:US
Practice Address - Phone:616-328-3756
Practice Address - Fax:616-284-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty