Community Counseling & Mentoring Services

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401011235 Issued in MI

Legal business name

COMMUNITY COUNSELING & MENTORING SERVICES

Practice address

312 Superior Mall
Port Huron, MI 48060-3833

Phone

(810) 987-2681

Fax

(810) 987-2784

NPI assigned

Feb 19, 2009

Organization subpart

No

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

Authorized official

Name

Karen Gavin, BA

Title

Managing Director

Phone

(810) 987-2681

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235001600000",
    "number": "1932348620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 SUPERIOR MALL",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603833",
            "telephone_number": "810-987-2681",
            "fax_number": "810-987-2784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 SUPERIOR MALL",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603833",
            "telephone_number": "810-987-2681",
            "fax_number": "810-987-2784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY COUNSELING & MENTORING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-19",
        "last_updated": "2009-02-19",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "810-987-2681",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401011235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; 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.