Provider Demographics
NPI:1871061911
Name:NORTHERN LIGHT COUNSELING PLLC
Entity type:Organization
Organization Name:NORTHERN LIGHT COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAWKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-326-2564
Mailing Address - Street 1:499 CENTURY LN STE 50
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4393
Mailing Address - Country:US
Mailing Address - Phone:616-326-2564
Mailing Address - Fax:855-256-6084
Practice Address - Street 1:499 CENTURY LN STE 50
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4393
Practice Address - Country:US
Practice Address - Phone:616-326-2564
Practice Address - Fax:855-256-6084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932520053Medicaid