Basic Information
| Provider Information | |||||||||
| NPI: | 1659762110 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COUNSELLOR | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 346 LONG RAPIDS PLZ | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497071374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893583500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 346 LONG RAPIDS PLZ | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497071374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893583500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2015 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC.0013306 | CO | N | Behavioral Health & Social Service Providers | Counselor | Professional | 225700000X | 7501005113 | MI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 101YP2500X | 6401009538 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.