Provider Demographics
NPI:1144525288
Name:HACKLEY LIFE COUNSELING
Entity type:Organization
Organization Name:HACKLEY LIFE COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN HORSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-726-3582
Mailing Address - Street 1:125 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5041
Mailing Address - Country:US
Mailing Address - Phone:231-726-3582
Mailing Address - Fax:231-722-6933
Practice Address - Street 1:125 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5041
Practice Address - Country:US
Practice Address - Phone:231-726-3582
Practice Address - Fax:231-722-6933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-21
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6100041041C0700X
MI68010741741041C0700X
MI68010024141041C0700X
MI68010855831041C0700X
MI68010796671041C0700X
MI68010816651041C0700X
MI68010743891041C0700X
MI68010853501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0910713OtherBCBS OUTPATIENT PSYCHIATRIC FACILITY
MIOF11343OtherBCBS PSYCHOLOGIST GROUP
MI20363OtherBCBS SUBSTANCE ABUSE FACILITY
MIOF10118OtherBCBS SOCIAL WORKER GROUP
MIOF11343OtherBCBS PSYCHOLOGIST GROUP
MIOF16408Medicare PIN
MI0910713OtherBCBS OUTPATIENT PSYCHIATRIC FACILITY
MIOP11010Medicare PIN