Healthcare Provider Details

I. General information

NPI: 1427967835
Provider Name (Legal Business Name): HALLE TARA SULLINS LLMSW, PSSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N FREER RD
CHELSEA MI
48118-1176
US

IV. Provider business mailing address

11383 CEDAR BEND DR
PINCKNEY MI
48169-9539
US

V. Phone/Fax

Practice location:
  • Phone: 734-433-2201
  • Fax: 734-433-2211
Mailing address:
  • Phone: 734-686-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851119947
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: