Provider Demographics
NPI:1255706925
Name:VIBRANT HEALTH COMPANY
Entity type:Organization
Organization Name:VIBRANT HEALTH COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW CAADC
Authorized Official - Phone:906-458-9501
Mailing Address - Street 1:917 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4413
Mailing Address - Country:US
Mailing Address - Phone:906-458-9501
Mailing Address - Fax:
Practice Address - Street 1:917 WILSON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4413
Practice Address - Country:US
Practice Address - Phone:906-458-9501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010802841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801080284OtherLICENSE