Unknown Individual – Mental Health Counselor, NPI 1003368408

Unknown Individual is a healthcare provider. based in Fort gratiot, Michigan. specializing in Mental Health Counselor. They hold a License No. 6401015730 (MI). The NPI Number for Unknown Individual is 1003368408

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1003368408
Phone
(586) 549-8887
Address
4045 BUCKLEY DR
Deactivation Date
1 March 2022
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 4045 BUCKLEY DR

    FORT GRATIOT, MI 480593600

    Phone: (586) 549-8887

    Type: Mailing

  • 805, Superior Street, Port Huron, Saint Clair County, Michigan, 48060, United States

    SUITE A

    PORT HURON, MI 480603771

    Phone: (810) 966-1972

    Fax: (810) 966-1973

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 48059)

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Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1003368408.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Mental Health Counselor. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Fort Gratiot, Michigan in registry-derived data.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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