Healthcare Provider Details

I. General information

NPI: 1720743602
Provider Name (Legal Business Name): SISU COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MONROE AVE NW
GRAND RAPIDS MI
49503-1445
US

IV. Provider business mailing address

2110 MONROE AVE NW
GRAND RAPIDS MI
49505-4046
US

V. Phone/Fax

Practice location:
  • Phone: 989-313-1620
  • Fax:
Mailing address:
  • Phone: 989-313-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA R MILLER
Title or Position: PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 989-313-1620