Provider Demographics
NPI:1881180651
Name:THIRD AGE COUNSELING LLC
Entity Type:Organization
Organization Name:THIRD AGE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:616-490-9118
Mailing Address - Street 1:2762 PINE DUNES CT SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9305
Mailing Address - Country:US
Mailing Address - Phone:616-490-9118
Mailing Address - Fax:855-490-2268
Practice Address - Street 1:2762 PINE DUNES CT SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-9305
Practice Address - Country:US
Practice Address - Phone:616-490-9118
Practice Address - Fax:855-490-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-05
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)