Provider Demographics
NPI:1720611528
Name:ORIGINS COUNSELING, PLLC
Entity Type:Organization
Organization Name:ORIGINS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TALERICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-335-5590
Mailing Address - Street 1:350 N 2ND AVE UNIT 41
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-6201
Mailing Address - Country:US
Mailing Address - Phone:248-894-3226
Mailing Address - Fax:
Practice Address - Street 1:3500 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:BLACK RIVER
Practice Address - State:MI
Practice Address - Zip Code:48721
Practice Address - Country:US
Practice Address - Phone:248-894-3226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty