Basic Information
| Provider Information | |||||||||
| NPI: | 1548651714 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL COUNSELING CENTER, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 SUPERIOR STREET | ||||||||
| Address2: | |||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109844202 | ||||||||
| FaxNumber: | 8109848896 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 SUPERIOR ST | ||||||||
| Address2: | |||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480603838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109844202 | ||||||||
| FaxNumber: | 8109848896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2015 | ||||||||
| LastUpdateDate: | 02/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | CAZA | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERIM EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8109844202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4301038492 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.