Provider Demographics
NPI:1306452586
Name:THE COUNSELING CENTER OF GREAT LAKES
Entity type:Organization
Organization Name:THE COUNSELING CENTER OF GREAT LAKES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART-OWNER AND CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVERGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLPC
Authorized Official - Phone:517-588-6169
Mailing Address - Street 1:6211 W WILLOW HWY # 199
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1231
Mailing Address - Country:US
Mailing Address - Phone:517-588-6169
Mailing Address - Fax:517-588-6169
Practice Address - Street 1:6211 W WILLOW HWY # 199
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1231
Practice Address - Country:US
Practice Address - Phone:517-588-6169
Practice Address - Fax:517-588-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty