Healthcare Provider Details

I. General information

NPI: 1033756580
Provider Name (Legal Business Name): CHARLISE TINDLE LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 E MOUNT HOPE AVE
LANSING MI
48910-1913
US

IV. Provider business mailing address

4394 DAVLIND DR
HOLT MI
48842-2070
US

V. Phone/Fax

Practice location:
  • Phone: 623-640-8521
  • Fax:
Mailing address:
  • Phone: 623-640-8421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017817
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: