Provider Demographics
NPI:1912954322
Name:HACKLEY LIFE COUNSELING
Entity Type:Organization
Organization Name:HACKLEY LIFE COUNSELING
Other - Org Name:MERCY HEALTH - LIFE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN HORSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-726-3582
Mailing Address - Street 1:125 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5041
Mailing Address - Country:US
Mailing Address - Phone:231-726-3582
Mailing Address - Fax:231-722-6933
Practice Address - Street 1:125 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5041
Practice Address - Country:US
Practice Address - Phone:231-726-3582
Practice Address - Fax:231-722-6933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-30
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI610004261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI028369OtherVALUE OPTIONS SUB ABUSE
MI031611000OtherMAGELLAN GROUP #
MIOF11343OtherBCBS PSYCHOLOGIST GROUP
MI20363OtherBCBS - SUBSTANCE ABUSE FACILITY
MIOF10118OtherBCS SOCIAL WORKER GROUP
MI030234OtherVALUE OPTIONS MENTAL HEAL
MI0910713OtherBCBS - OPC
MIOF10118OtherBCS SOCIAL WORKER GROUP
MIOF10118OtherBCS SOCIAL WORKER GROUP
MIOF16408Medicare PIN