Provider Demographics
NPI:1861693848
Name:VARNEY, MICHAEL WALLACE (LLP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WALLACE
Last Name:VARNEY
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:CASPIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49915-0047
Mailing Address - Country:US
Mailing Address - Phone:906-265-5455
Mailing Address - Fax:
Practice Address - Street 1:217 NORTH 10TH AVENUE
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935
Practice Address - Country:US
Practice Address - Phone:906-265-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013523103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical