Basic Information
| Provider Information | |||||||||
| NPI: | 1932232816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEATHERLY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | WARNER | ||||||||
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| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 301 EXPLORER ST | ||||||||
| Address2: | |||||||||
| City: | GWINN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498412813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063464924 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | HANCOCK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499301452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064831060 | ||||||||
| FaxNumber: | 9063723230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 68011027525 | MI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 6801102725 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 6801114295 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.