Healthcare Provider Details

I. General information

NPI: 1417497488
Provider Name (Legal Business Name): MICHELLE LEIGH CILOSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 W SAINT JOSEPH ST STE B301
LANSING MI
48917-5606
US

IV. Provider business mailing address

3815 W SAINT JOSEPH ST STE B301
LANSING MI
48917-5606
US

V. Phone/Fax

Practice location:
  • Phone: 517-230-5727
  • Fax:
Mailing address:
  • Phone: 517-230-5727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: