Provider Demographics
NPI:1982241964
Name:MARQUETTE COUNSELING SERVICE
Entity Type:Organization
Organization Name:MARQUETTE COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:906-360-7472
Mailing Address - Street 1:MARQUETTE COUNSELING SERVICES
Mailing Address - Street 2:112 W WASHINGTON STREET STE A
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-360-7472
Mailing Address - Fax:906-475-8748
Practice Address - Street 1:LORI JOHNSON
Practice Address - Street 2:112 W WASHINGTON STREET STE A
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3844
Practice Address - Country:US
Practice Address - Phone:906-360-7472
Practice Address - Fax:906-475-8748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health