Provider Demographics
NPI:1609251545
Name:GREAT LAKES HOLISTIC COUNSELING
Entity type:Organization
Organization Name:GREAT LAKES HOLISTIC COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDES
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LPC
Authorized Official - Phone:412-592-5834
Mailing Address - Street 1:4906 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1978
Mailing Address - Country:US
Mailing Address - Phone:412-592-5834
Mailing Address - Fax:
Practice Address - Street 1:4906 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1978
Practice Address - Country:US
Practice Address - Phone:412-592-5834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007128101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty