MEDICARE: SONDER PSYCHOLOGY AND COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1265320089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONDER PSYCHOLOGY AND COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1611 W CENTRE AVE STE 108
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-5344
Country	:	US
Telephone Number	:	269-366-8858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 W CENTRE AVE STE 108
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-5344
Country	:	US
Telephone Number	:	269-225-5148
Fax Number	:

Authorized Official
Title or Position	:	COUNSELING PSYCHOLOGIST
Name	:	CARLY LACELLE
Credential	:	MA
Telephone Number	:	269-366-8858

Provider Enumeration Date	:	06/27/2025
Last Update Date	:	05/06/2026

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