Provider Demographics
NPI:1043051667
Name:MICHIGAN WELLNESS SERVICES
Entity type:Organization
Organization Name:MICHIGAN WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BACKING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-238-6690
Mailing Address - Street 1:1401 60TH ST SE STE B
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7065
Mailing Address - Country:US
Mailing Address - Phone:616-238-6690
Mailing Address - Fax:
Practice Address - Street 1:1401 60TH ST SE STE B
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-7065
Practice Address - Country:US
Practice Address - Phone:616-238-6690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty