Provider Demographics
NPI:1205595238
Name:LANTERN COUNSELING LLC
Entity type:Organization
Organization Name:LANTERN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:NERESON-BOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-826-9662
Mailing Address - Street 1:2601 HAGUE AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-2335
Mailing Address - Country:US
Mailing Address - Phone:616-826-9662
Mailing Address - Fax:
Practice Address - Street 1:4764 FULTON ST E
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9086
Practice Address - Country:US
Practice Address - Phone:616-378-6201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty