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Organization

ETCH

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY BETH HOUPT (CREDENTIALING)
(517) 676-9797
Entity
Organization

Contact information

Practice address
909 ABBOT RD STE B, EAST LANSING, MI 48823-3168
(269) 430-3122
Mailing address
PO BOX 10, MASON, MI 48854-0010
(517) 676-9788
(517) 676-3438

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1041C0700X
Clinical Social Worker
2084P0800X
Psychiatry Physician

Other

Enumeration date
09/08/2014
Last updated
03/06/2024
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