Organization
TRAVERSE BAY COUNSELING & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACALYN LASICH LMSW (OWNER/COUNSELOR)
(231) 735-2270
Entity
Organization
Contact information
Practice address
3301 VETERANS DR, SUITE 124, TRAVERSE CITY, MI 49684-4574
(231) 735-2270
Mailing address
2177 HOLLAND CIR, TRAVERSE CITY, MI 49685-7945
(231) 590-4716
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
6801089753
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0961729
BCBSM PIN
MI
05
—
1487909396
—
MI
Enumeration date
05/03/2014
Last updated
05/03/2014
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