Provider Demographics
NPI:1053591289
Name:NORTHERN COUNSELING SERVICES PC
Entity type:Organization
Organization Name:NORTHERN COUNSELING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSW/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSETTERS
Authorized Official - Suffix:
Authorized Official - Credentials:CSW ACSW
Authorized Official - Phone:616-696-4034
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-0329
Mailing Address - Country:US
Mailing Address - Phone:616-696-4034
Mailing Address - Fax:
Practice Address - Street 1:261 N MAIN
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8041
Practice Address - Country:US
Practice Address - Phone:616-696-4034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801035649251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008971700OtherBCBS
MI2820641Medicaid
MI8008971700OtherBCBS