Basic Information
Provider Information | |||||||||
NPI: | 1427373745 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | THE GUIDANCE CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 13101 ALLEN RD | ||||||||
Address2: | SUITE 500 | ||||||||
City: | SOUTHGATE | ||||||||
State: | MI | ||||||||
PostalCode: | 481952216 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7347857700 | ||||||||
FaxNumber: | 7342878003 | ||||||||
Practice Location | |||||||||
Address1: | 13101 ALLEN RD | ||||||||
Address2: | SUITE 500 | ||||||||
City: | SOUTHGATE | ||||||||
State: | MI | ||||||||
PostalCode: | 481952216 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7347857700 | ||||||||
FaxNumber: | 7342878003 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/30/2010 | ||||||||
LastUpdateDate: | 03/30/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LOTT | ||||||||
AuthorizedOfficialFirstName: | LEROY | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 7347857700 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: | JR. | ||||||||
AuthorizedOfficialCredential: | MSW,LMSW | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
ID Information
ID | Type | State | Issuer | Description | 20555 | 01 | MI | BCBS SA RIDER | OTHER | 750910723 | 01 | MI | BCBS OPC | OTHER |