Provider Demographics
NPI:1396585840
Name:REAL LIFE COUNSELING OF NORTHERN MICHIGAN
Entity type:Organization
Organization Name:REAL LIFE COUNSELING OF NORTHERN MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-622-5800
Mailing Address - Street 1:410 E LAKE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2437
Mailing Address - Country:US
Mailing Address - Phone:231-622-5800
Mailing Address - Fax:231-272-5721
Practice Address - Street 1:410 E LAKE ST STE 100
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2437
Practice Address - Country:US
Practice Address - Phone:231-622-5800
Practice Address - Fax:231-272-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty