Provider Demographics
NPI:1154562635
Name:SUSAN C. GUERRIERO COUNSELING SERVICE
Entity type:Organization
Organization Name:SUSAN C. GUERRIERO COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUERRIERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-780-9680
Mailing Address - Street 1:612 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1907
Mailing Address - Country:US
Mailing Address - Phone:517-780-9680
Mailing Address - Fax:517-780-9681
Practice Address - Street 1:612 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1907
Practice Address - Country:US
Practice Address - Phone:517-780-9680
Practice Address - Fax:517-780-9681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010039701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP62260Medicare PIN