Healthcare Provider Details

I. General information

NPI: 1316311558
Provider Name (Legal Business Name): JULIA TARSA MA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2015
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 E CESAR E CHAVEZ AVE
LANSING MI
48906-5441
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-881-7276
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401005735
License Number StateMI

VIII. Authorized Official

Name: JULIA TARSA
Title or Position: OWNER
Credential: LPC
Phone: 517-881-7276