Provider Demographics
NPI:1306399613
Name:HILLSDALE COLLEGE
Entity type:Organization
Organization Name:HILLSDALE COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BROCK
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:517-607-2561
Mailing Address - Street 1:33 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1205
Mailing Address - Country:US
Mailing Address - Phone:517-437-7341
Mailing Address - Fax:517-607-2222
Practice Address - Street 1:33 E. COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242
Practice Address - Country:US
Practice Address - Phone:517-437-7341
Practice Address - Fax:517-607-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704212731163W00000X
MI012733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty