Organization
LAKEVIEW FAMILY COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIRLEY JO WILSON MA,LPC (OWNER)
(517) 403-4950
Entity
Organization
Contact information
Practice address
765 MANITOU ROAD, MANITOU BEACH, MI 49253
(517) 403-4950
(517) 252-5135
Mailing address
765 MANITOU ROAD, MANITOU BEACH, MI 49253
(517) 403-4950
(517) 252-5135
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401011390
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401011390
STATE LICENSE
MI
Enumeration date
08/15/2013
Last updated
08/15/2013
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