Provider Demographics
NPI:1699712588
Name:COUNSELING AND PSYCHOLOGICAL SERVICES OF THREE RIVERS P.C.
Entity type:Organization
Organization Name:COUNSELING AND PSYCHOLOGICAL SERVICES OF THREE RIVERS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:BORGERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:269-278-2003
Mailing Address - Street 1:30 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-1532
Mailing Address - Country:US
Mailing Address - Phone:269-278-2003
Mailing Address - Fax:269-278-1507
Practice Address - Street 1:30 N MAIN ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-1532
Practice Address - Country:US
Practice Address - Phone:269-278-2003
Practice Address - Fax:269-278-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008346103TC0700X
MI68010657511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N75810Medicare ID - Type UnspecifiedMARY LOU BORGERT PH.D.