Country-Side Counseling & Consultation Services, PC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

COUNTRY-SIDE COUNSELING & CONSULTATION SERVICES, PC

Practice address

388 N 3Rd Ave
Suite F
Fruitport, MI 49415-9785

Phone

(231) 571-0082

NPI assigned

Apr 8, 2010

Last updated

Oct 27, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Roger Dale Bayne, L.P.C

Title

President

Phone

(231) 571-0082

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477526400000",
    "number": "1184940751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "388 N 3RD AVE",
            "address_2": "SUITE F",
            "city": "FRUITPORT",
            "state": "MI",
            "postal_code": "494159785",
            "telephone_number": "231-571-0082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "388 N 3RD AVE",
            "address_2": "SUITE F",
            "city": "FRUITPORT",
            "state": "MI",
            "postal_code": "494159785",
            "telephone_number": "231-571-0082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY-SIDE COUNSELING & CONSULTATION SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-08",
        "last_updated": "2016-10-27",
        "status": "A",
        "authorized_official_last_name": "BAYNE",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-571-0082",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.P.C"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sameen Bashir Butt, M.D.
• CCR Home Health Care
• Jacob Charron, MD
• Chelsea Klipfel, D.D.S., P.L.L.C. (Fruitport Family Dentistry)
• Christopher Sortman DDS, P.C. (Community Shores Dental)
• Delphia Croff, NURSE PRACTITIONER
• Allison Nichole Crowl, MD
• Nathan Dills, DO
• Donna L Rick DDS PC
• David Leon Dora, D.O.

• Mental Health Counselor in Fruitport, MI
• Providers in Fruitport, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.