Organization
PATHWAYS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA A NELSON (CREDENTIALING COORDINATOR)
(906) 233-1236
Entity
Organization
Contact information
Practice address
200 W SPRING ST, MARQUETTE, MI 49855-4630
(906) 225-7210
Mailing address
200 W SPRING ST, MARQUETTE, MI 49855-4630
(906) 225-7210
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1724945
—
MI
Enumeration date
07/01/2006
Last updated
03/17/2018
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