Provider Demographics
NPI:1831739010
Name:STATE OF MICHIGAN
Entity type:Organization
Organization Name:STATE OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELKNAP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-335-1575
Mailing Address - Street 1:PO BOX 30652
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-8152
Mailing Address - Country:US
Mailing Address - Phone:517-241-1100
Mailing Address - Fax:517-335-5140
Practice Address - Street 1:201 N WASHINGTON SQ FL 2
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-1328
Practice Address - Country:US
Practice Address - Phone:517-241-1100
Practice Address - Fax:517-335-5140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Single Specialty