Portage Life Coaching and Counseling LLP

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

PORTAGE LIFE COACHING AND COUNSELING LLP

Practice address

10032 Shaver Rd
Portage, MI 49024-6738

Phone

(269) 993-9977

NPI assigned

Aug 7, 2020

Organization subpart

No

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

Authorized official

Name

Gerald Brooks

Title

Ceo

Phone

(269) 447-8758

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1596758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1366052011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10032 SHAVER RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490246738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10032 SHAVER RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490246738",
            "telephone_number": "269-993-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTAGE LIFE COACHING AND COUNSELING LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-07",
        "last_updated": "2023-11-27",
        "certification_date": "2020-08-07",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "269-447-8758"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "-",
            "affiliation": "Y",
            "affiliationName": "Sankofa Counseling & Consulting",
            "address_1": "10032 Shaver Rd",
            "city": "Portage",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490246738",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Social Worker in Portage, MI
• Providers in Portage, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.