Healthcare Provider Details

I. General information

NPI: 1053760231
Provider Name (Legal Business Name): LIFESKILLS PSYCHOLOGICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S CARMEL ST
CADILLAC MI
49601-2344
US

IV. Provider business mailing address

805 S CARMEL ST
CADILLAC MI
49601-2344
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-6517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301016675
License Number StateMI

VIII. Authorized Official

Name: DR. MICHELLE MORSE
Title or Position: PHD
Credential:
Phone: 231-775-6517