The Men'S Counseling Center of Northern Michigan, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

6301009941 Issued in MI

Legal business name

THE MEN'S COUNSELING CENTER OF NORTHERN MICHIGAN, LLC

Practice address

2202 Mitchell Park Dr
Suite 2B
Petoskey, MI 49770-8897

Phone

(231) 487-0025

Fax

(231) 487-1754

NPI assigned

May 22, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Charles David Donaldson, LLP

Title

Psychologist

Phone

(231) 487-0025

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1432252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432252800000",
    "number": "1821477845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 MITCHELL PARK DR",
            "address_2": "SUITE 2B",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708897",
            "telephone_number": "231-487-0025",
            "fax_number": "231-487-1754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 MITCHELL PARK DR",
            "address_2": "SUITE 2B",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708897",
            "telephone_number": "231-487-0025",
            "fax_number": "231-487-1754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MEN'S COUNSELING CENTER OF NORTHERN MICHIGAN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-22",
        "last_updated": "2015-05-22",
        "status": "A",
        "authorized_official_last_name": "DONALDSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "231-487-0025",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LLP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "6301009941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2015; 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.