Provider Demographics
NPI:1972824480
Name:INLAND SEAS COUNSELING, LLC
Entity Type:Organization
Organization Name:INLAND SEAS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KOLLHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:231-775-7660
Mailing Address - Street 1:3056 TIBBETS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-9120
Mailing Address - Country:US
Mailing Address - Phone:231-775-7660
Mailing Address - Fax:231-421-3239
Practice Address - Street 1:1020 HASTINGS ST STE 105
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3457
Practice Address - Country:US
Practice Address - Phone:231-775-7660
Practice Address - Fax:231-421-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12122772OtherCAQH