Provider Demographics
NPI:1013430545
Name:NEW DIRECTIONS COUNSELING AND NEUROBEHAVIORAL CENTER, LLC
Entity Type:Organization
Organization Name:NEW DIRECTIONS COUNSELING AND NEUROBEHAVIORAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP, LPC
Authorized Official - Phone:989-684-6832
Mailing Address - Street 1:2355 DELTA RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-9340
Mailing Address - Country:US
Mailing Address - Phone:989-684-6832
Mailing Address - Fax:989-684-4856
Practice Address - Street 1:2355 DELTA RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9340
Practice Address - Country:US
Practice Address - Phone:989-684-6832
Practice Address - Fax:989-684-4856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW DIRECTIONS COUNSELING AND NEUROBEHAVIORAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23114147001522OtherMEDICARE