Provider Demographics
NPI: | 1790284644 |
---|---|
Name: | TRUE NORTH COUNSELING SERVICES PLLC |
Entity Type: | Organization |
Organization Name: | TRUE NORTH COUNSELING SERVICES PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CREDENTIALING |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARYBETH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HOUPT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 517-676-9788 |
Mailing Address - Street 1: | PO BOX 10 |
Mailing Address - Street 2: | |
Mailing Address - City: | MASON |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48854-0010 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 302 E CASS ST |
Practice Address - Street 2: | |
Practice Address - City: | CADILLAC |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49601-2170 |
Practice Address - Country: | US |
Practice Address - Phone: | 231-429-1226 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-02-06 |
Last Update Date: | 2018-02-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4101006668 | 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Single Specialty |