Healthcare Provider Details

I. General information

NPI: 1952596728
Provider Name (Legal Business Name): SHASTA SITTON MS, LMHC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHASTA CUMMINGS MS

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 TURTLE LAKE RD UNIT 2
HILLMAN MI
49746-8000
US

IV. Provider business mailing address

5215 TURTLE LAKE RD UNIT 2
HILLMAN MI
49746-8000
US

V. Phone/Fax

Practice location:
  • Phone: 989-351-9091
  • Fax:
Mailing address:
  • Phone: 989-351-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60068109
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6301016685
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: