Colloquium Counseling and Consultation, PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

6801099286 Issued in MI

Legal business name

COLLOQUIUM COUNSELING AND CONSULTATION, PLLC

Practice address

902 S Higby St
Jackson, MI 49203-2873

Phone

(312) 610-9552

NPI assigned

Feb 8, 2017

Last updated

Feb 8, 2017By 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. Michael Joseph Kristovic, LMSWNPI 1518254614

Title

Owner

Phone

(312) 610-9552

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Joseph Kristovic, L.C.S.W.

  • Clinical Social Worker
  • Jackson, MI
  • NPI 1518254614
  Authorized official Same address or phone

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

{
    "created_epoch": "1486512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486512000000",
    "number": "1609314814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 S HIGBY ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492032873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 S HIGBY ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492032873",
            "telephone_number": "312-610-9552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLOQUIUM COUNSELING AND CONSULTATION, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-08",
        "last_updated": "2017-02-08",
        "status": "A",
        "authorized_official_last_name": "KRISTOVIC",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-610-9552",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "6801099286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Jackson, MI
• Providers in Jackson, MI by specialty
• Community/Behavioral Health Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; 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.