Provider Demographics
NPI:1851015820
Name:MIRRORED WATERS COUNSELING
Entity Type:Organization
Organization Name:MIRRORED WATERS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEVERICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:231-676-8711
Mailing Address - Street 1:1005 MAY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9380
Mailing Address - Country:US
Mailing Address - Phone:231-676-8711
Mailing Address - Fax:231-308-5935
Practice Address - Street 1:1005 MAY ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9380
Practice Address - Country:US
Practice Address - Phone:231-676-8711
Practice Address - Fax:231-308-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty