| NPI | 1912334830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ANNE-JULIN FORRESTER Sngl Member Owner/Provider 231-735-8338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401012209) |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2023-12-11 |