Healthcare Provider Details

I. General information

NPI: 1780359786
Provider Name (Legal Business Name): SKYLER NUNEZ LLC
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: SKYLER BLANKENSHIP LLC

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 N CLARE AVE
HARRISON MI
48625-8250
US

IV. Provider business mailing address

789 N CLARE AVE
HARRISON MI
48625-8250
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451022434
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: