Provider Demographics
NPI:1730370206
Name:PARK PLACE COUNSELING & ASSOCIATE PLC
Entity type:Organization
Organization Name:PARK PLACE COUNSELING & ASSOCIATE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP LPC CAAC
Authorized Official - Phone:269-383-1440
Mailing Address - Street 1:157 S KALAMAZOO MALL
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4877
Mailing Address - Country:US
Mailing Address - Phone:269-383-1440
Mailing Address - Fax:269-383-9781
Practice Address - Street 1:157 S KALAMAZOO MALL
Practice Address - Street 2:SUITE 250
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4877
Practice Address - Country:US
Practice Address - Phone:269-383-1440
Practice Address - Fax:269-383-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1426Medicare PIN